UNIVERSITY  OF  CALIFORNIA 

ANDREW 

SMITH 

HALLIDIL: 

REGENT 


THE 


HOMCSOPATHIC 


THEORY   AND    PRACTICE 


MEDICINE. 

BY   E.   E.   MAKCY,    M.D. 


Second  Edition. 


NEW-YORK: 
WILLIAM    RADDE,     322    BROADWAY 

C.  L.  BADEMACHEB  &  SHEEK,  239  ARCH-STREET,  PHILADELPHIA; 

OTIS   CLAFP,   SCHOOL-STREET,   BOSTON  ; 
J.  G.  WESSELHffiFT,   91  MARKET  STREET,   ST.  LOUIS. 

1852. 


BIOLOGY 
LIBRARY 


ENTERED,  according  to  Act  of  Congress,  in  the  year  1852,  by 

WILLIAM  RADDE, 
In  the  Clerk's  Office  of  the  District  Court  for  the  Southern  District  of  New-York 


Angel),  Engel  &  Hewitt, 

Printers, 
No.  ISpruce-st,,  N.  Y. 


PREFACE. 


THE  profession  of  the  art  and  science  of  renewing  and  preserving 
health  has,  in  all  periods  and  in  all  nations,  been  held  to  be  of  the 
highest  dignity,  for  the  devotion  and  bravery  necessary  in  those 
who  adopt  it,  as  well  as  for  its  association,  as  ameliorator,  with 
almost  every  form  of  human  suffering.  In  its  widest  and  justest 
acceptation,  it  may  be  said  to  be  the  sum  of  logic,  since  nearly  all 
knowledge,  in  metaphysics  as  well  as  in  physics,  is  necessary  to 
the  thorough  understanding  and  the  illustration  of  its  various  prin 
ciples  and  phenomena. 

In  an  age  preeminently  distinguished  for  intellectual  as  well  as 
for  physical  activity,  the  theories  of  disease  and  cure  have  shared 
the  general  advancement,  and  the  new  doctrines  that  have  obtained, 
for  their  elucidation  and  practical  application,  demand  a  new  lite 
rature.  Since  the  discoveries  of  the  Newton  of  Medicine,  old  trea 
tises,  founded  upon  erroneous  and  soon  to  be  obsolete  hypotheses, 
are,  for  the  most  part,  comparatively  valueless,  except  for  purposes 
of  history.  Everything  is  to  be  reconstructed.  Much  has  indeed 
been  done  in  Europe  and  in  this  country,  since  the  announcement 
of  the  true  laws  of  cure,  yet  so  little  in  proportion  to  the  neces 
sity,  that  no  apology  will  be  required  for  this  attempt  to  occupy 
one  of  the  chief  places  of  dethroned  but  still  unsilenced  Error. 

At  the  beginning  of  a  system  of  Theory  and  Practice,  produced 
under  such  circumstances,  and  for  such  purposes,  it  is  appropriate 
to  disclose  briefly  its  leading  characteristics,  and  especially  the 
positions  it  occupies  in  relation  to  points  which  may  be  considered 
still  unsettled  and  debateable.  The  grand  proposition,  similia 
similibus  curantur,  is  not  only  the  basis  of  the  homoeopathic  me 
thod,  but  is  also,  we  believe,  the  hitherto  unknown  law  of  the  most 
successful  treatment  by  the  allopathists.  Whether  we  advocate 
the  use  of  high  or  low  attenuations,  or  believe  in  the  topical  and 
material,  or  the  dynamical  and  immaterial  action  of  drugs,  are 


1 07338 


v  PREFACE. 

matters  of  proportionably  little  importance,  while  we  abide  by  this 
fundamental  doctrine  in  the  practical  application  of  remedies.  The 
physician  of  the  old  school,  who  cures  delirium  tremens  with  a 
large  dose  of  opium,  acts  as  strictly  in  accordance  with  the  theory 
of  Hahnemann,  as  he  who  cures  it  with  a  high  attenuation  of  the 
same  drug,  but  with  this  diiference — that  the  treatment  of  the 
former  is  attended  with  danger,  and  the  restoration  is  slow,  tedious, 
and  defective,  while  the  primary  specific  impression  by  the  philo 
sophical  process  is  slight,  and  the  curative  reaction  of  the  organism 
speedy,  complete,  and  permanent. 

Although  the  question  of  doses  is  of  considerable  importance  in 
individual  cases,  yet  too  much  stress  has  been  laid  upon  it  by  the 
advocates  of  both  high  and  low  attenuations.  We  are  constantly 
presented  with  well-authenticated  cures  by  the  undiluted  tinctures 
and  low  dilutions,  and  have  also  as  thoroughly  understood  and 
successfully  practised  the  high  attenuations.  We  occasionally 
see,  too,  that  strong  preparations  afford  prompt  relief  where  the 
weaker  have  failed,  and  vice  versa.  Some  constitutions  may  be 
powerfully  acted  on  by  a  thirtieth,  while  others  will  not  respond  to 
any  weaker  than  a  first  dilution.  The  different  conditions  of  the 
tissues  likewise  offer  the  most  varied  and  important  modifications 
with  reference  to  the  effects  of  agents.  How  absurd,  then,  to  fix 
upon  this  or  that  attenuation,  and  to  make  use  of  the  term  high  or 
low  dilutionist,  when  we  have  to  deal  with  organisms  of  every 
possible  grade  of  delicacy  and  susceptibility,  and  with  morbid  con 
ditions  which,  in  some  instances,  may  be  modified  by  even  a  men 
tal  emotion,  and  in  others  only  by  the  strongest  tinctures. 

We  say,  therefore,  to  the  true  homoROpathist,  let  the  grand  max 
im  of  HAHNEMANN,  similia  similibus  curantur,  be  our  prime  and 
constant  rule  of  medical  faith  and  practice  ;  but  never  attempt  to 
confine  our  doses  within  the  narrow  limits  of  the  ultraists  of  either 
party,  for  the  unanswerable  reason,  that  the  susceptibilities  of  the 
tissues  to  medicinal  impressions  vary  in  precise  accordance  with 
the  degrees  of  inflammation  and  nervous  erethism.  From  a  con 
dition  of  health,  or  a  slight  irritation  of  the  textures,  up  to  a  high 
point  of  inflammatory  action,  or  nervous  excitability,  there  are 
almost  innumerable  gradations  of  impressibility  ;  and  he  who  would 
prescribe  wisely  and  successfully,  must  select  his  attenuations,  and 
order  his  repetitions  with  strict  regard  to  these  degrees.  Of  this 
subject  we  have  treated  at  some  length  in  chapter  VII. 

In  our  observations  on  general  pathology  and  therapeutics,  we 
have  endeavoured  to  explain  what  we  believe  to  be  the  true  nature 
of  inflammation,  and  have  pointed  out  some  of  the  more  general 
means  of  avoiding  and  counteracting  the  causes  of  inflammatory 


PREFACE.  V 

action.  In  forming  many  of  our  inferences,  we  have  been  indebted 
to  the  recent  labours  of  Liebig,  Miiller,  Matteucci,  Flourens,  Ma- 
jendie,  and  Philip.  Although  the  views  advanced  have  no  material 
bearing  upon  the  homoeopathic  doctrine  of  cure,  yet  if  they  illus 
trate  this  most  important  of  the  subjects  connected  with  the  mor 
bid  conditions  of  the  economy,  we  shall  have  done  well  for  medical 
science.  We  are  aware  that  Liebig  has  carried  some  of  his  che 
mical  hypotheses  farther  than  facts  or  logic  warrant,  but  admit 
that  many  of  his  positions,  as  to  the  production  of  animal  heat,  the 
metamorphoses  of  the  tissues,  the  supply  and  waste  of  the  con 
stituents  of  the  structures,  and  the  phenomena  of  inflammation, 
are  in  the  main  correct.  If  he  errs  in  supposing  that  all  the  phe 
nomena  of  life  are  attributable  to  chemical  action,  that  the  human 
body  is  subject  to  the  same  laws  as  inert  matter,  and  that  the  mass 
of  blood  may  be  contaminated  by  contact  with  substances  in  de 
composition  with  a  similar  kind  of  degeneration,  he  has  also 
shown  truly  that  chemical  action  has  at  least  an  important  influence 
in  the  operations  of  the  functions.  Let  not,  therefore,  his  mistakes 
prevent  a  rigid  scrutiny  of  his  opinions,  that  we  may  reject  the 
untenable,  and  appropriate  the  true. 

Believing  and  advocating  the  doctrine  of  absorption  and  the 
topical  action  of  drugs,  we  have  derived  numerous  arguments 
for  our  views  from  the  recent  experiments  of  Matteucci,  Flou 
rens,  Rau,  Miiller,  Blake,  and  Majendie.  These  profound  in 
vestigators  have  demonstrated  that  most  medicinal  substances  pos 
sess  well  defined  specific  properties,  and  that  it  is  necessary  to 
their  legitimate  effects,  that  they  be  absorbed  and  conveyed  by  the 
blood — as  a  medium  merely — to  the  tissues  for  which  they  have 
affinity,  there  to  operate  (probably  upon  the  sentient  nerves),  by 
actual  contact.  The  very  numerous  and  accurate  experiments  with 
almost  every  known  drug,  instituted  by  these  physiologists  upon 
animals,  are  quite  conclusive  as  to  the  point  of  the  absorption  and 
topical  action  of  remedies.  We  have  repeated  many  of  their  ex 
periments,  and  have  made  a  great  variety  of  new  ones  for  the 
therapeutical  illustration  of  the  subject,  and  have  thus  formed  from 
facts  alone,  the  conclusions  we  have  here  announced,  as  to  the  man 
ner  in  which  remedial  agents  operate.  The  scope  and  design  of 
this  treatise  will  not  permit  a  detail  of  these  interesting  experi 
ments  and  their  results,  but  we  hope  hereafter  to  submit  them  to 
the  public.  In  the  meanwhile,  attention  is"  invited  to  the  chapter 
in  which  we  have  treated  of  this  subject. 

There  is  another  doctrine  now  entertained  by  a  majority  of  the 
physicians  of  both  schools,  but  in  no  way  connected  with  our 
theory  of  cure,  to  which  we  have  devoted  special  attention  ;  we 


VI  PREFACE. 

mean  that  so  often  advanced  respecting  what  are  called  "  vital 
properties  "  of  parts — a  nervous  fluid — a  dynamic  influence,  differ 
ent  from  the  soul.  We  object  to  these  terms  because  they  are 
merely  arbitrary,  and  are  used  to  designate  properties  which  have 
no  real  existence ;  because,  as  Matteucci  well  observes,  they  may 
have  no  meaning,  or  may  mean  everything.  The  vitalists  define 
disease  to  consist  in  an  alteration  of  the  vital  properties  of  parts. 
But  what  are  these  vital  properties  1  Are  they  material  or  spiritual  ? 
something  or  nothing  1  What  is  the  nature  and  what  are  the  pro 
cesses  of  their  influence  1  We  are  told  that  miasmata  act  dynamical 
ly  or  spiritually  upon  the  vital  properties  of  the  tissues ;  but  what  are 
miasmata  but  minute  particles  of  vegetable  matter,  subdivided  by 
heat  and  moisture,  and  so  diffused  in  imponderable  forms  through 
the  air  1  Have  these  atoms  really  lost  their  material  form  or 
weight,  and  become  annihilated  ?  Can  a  material  substance,  by  any 
means,  be  reduced  into  an  immaterial  nothing,  and  retain  its  iden 
tity  or  individuality  1  In  other  words,  can  matter  be  transformed 
into  spirit  ?  Surely,  no ;  but  we  may  subdivide  substances  so 
minutely  as  not  to  be  able,  by  our  most  delicate  tests,  to  detect 
them  ;  yet  they  may  have  affinities,  and  be  capable  of  combina 
tions  with  other  atoms,  and  of  producing  other  material  effects 
when  brought  into  contact  with  certain  tissues  of  the  organism. 
When  these  material  4not  dynamic  or  spiritual)  particles  have 
reached  the  structures  to  which  they  have  specific  relations,  they 
impress  the  sentient  extremities  of  the  nerves,  so  that  the  capil 
laries  and  other  parts  over  which  these  nerves  preside,  respond  to 
their  impression,  and  there  are  chills,  followed  by  inflammations. 
It  is  evident,  then,  in  this  and  other  analogous  instances,  that  a 
material  agent  operates  topically  upon  the  tissues,  thus  impairing 
the  normal  integrity  of  the  parts,  but  not  dynamically  upon  certain 
(assumed)  vital  properties. 

The  general  principles  of  allopathy  we  have  briefly  considered 
and  compared  with  those  of  homoeopathy  ;  but  want  of  space  has 
prevented  such  elaborate  discussion  of  these  subjects  as  was  de 
manded  by  their  interest  and  importance.  We  trust,  however, 
that  what  we  have  written  may  attract  attention,  particularly  to 
the  real  points  at  issue  between  the  schools,  and  that  the  shafts  of 
our  antagonists  may  hereafter  be  directed  against  our  distinctive 
principle  of  cure,  rather  than  against  our  doses,  and  the  exhibition 
of  our  remedies. 

Hahnemann,  and  some  other  writers  of  eminence,  have  ex 
pressed  doubts  respecting  the  utility  of  the  common  classifications 
of  diseases,  since  descriptions  must  necessarily  be  general  and 
imperfect.  In  a  therapeutical  point  of  view,  this  distrust  of  clas- 


PREFACE.  Vll 

sifications  is  reasonable,  and  it  has  probably  arisen  from  the  custom 
with  the  old  school,  of  bringing  the  symptoms  of  every  disease 
under  some  one  general  head,  and  prescribing  for  the  congeries, 
however  diverse  the  separate  elements,  under  a  particular  name. 
For  example,  the  allopathist  called  to  a  patient  with  febrile  symp 
toms,  finds  a  rapid  pulse,  a  hot  and  dry  skin,  headache,  pains  in 
the  back  and  loins,  oppression  at  the  praecordia,  restlessness  and 
irritabilility,  foul  tongue,  thirst,  scanty  and  high-coloured  urine, 
confusion  of  ideas,  and  nightly  delirium.  He  is  now  to  arrange 
these  symptoms  under  one  of  the  general  heads  of  his  classification, 
but  is  at  a  loss  whether  to  call  it  typhus,  bilious,  or  inflammatory, 
sthenic  or  asthenic.  The  case,  however,  admits  of  no  delay,  and 
he  arbitrarily  decides  that  it  is  bilious,  and  bleeds,  vomits,  and 
purges,  well  knowing  that  if  it  proves  a  typhus,  he  can  persuade 
himself  and  the  patient's  friends  that  it  has  degenerated  from  one 
type  into  another.  He  forgets  to  make  known  that  copious  vene 
section,  emetics,  and  cathartics,  are  deemed  by  many  of  the  most 
intelligent  of  his  own  school,  to  be  fatal  in  typhus,  and  attributes 
all  evils  to  the  versatile  and  intractable  nature  of  the  malady,  while 
complacently  appropriating  to  himself  whatever  credit  may  chance 
to  accrue  from  favourable  symptoms.  On  the  other  hand,  if  he 
had  regarded  the  disease  as  a  typhus,  and  pursued  the  expectant 
or  tonic  treatment  sanctioned  in  his  school,  and  it  had  proved  an 
inflammatory  fever,  lesions  might  have  taken  place,  and  the  pa 
tient  might  have  succumbed  from  the  inefficiency  of  his  remedies. 
Objections  of  a  similar  nature  apply  in  a  majority  of  the  classifi 
cations  treated  by  the  allopathist.  But  while  it  is  unquestionable 
that  all  these  are  useless  as  guides  in  the  application  of  remedies, 
it  must  be  conceded  that  they  enable  us  to  concentrate  groups  of 
symptoms  under  appropriate  heads,  and  thus  to  arrive  more  con 
veniently  at  just  conclusions  respecting  the  nature  of  diseases. 
Accordingly,  in  this  treatise,  we  have  adopted  a  classification 
varying  little  from  those  usually  employed,  which  we  believe  will 
facilitate  the  true  apprehension  of  disordered  conditions.  We 
have  described  the  diseases  of  the  separate  systems  under  the 
same  head,  instead  of  treating  of  acute  varieties  in  one  part  of  the 
work,  and  of  chronic  in  another.  This  course  has  been  deemed 
proper  on  account  of  the  difficulty,  in  many  cases,  of  fixing  the 
line  of  demarcation  between  acute  and  chronic  affections,  and  for 
convenience  of  reference  to,  and  of  comparison  of  the  different 
diseases  of  the  same  system. 

In  arranging  the  symptoms  which  demand  particular  medicines, 
we  have  adopted  the  following  classification  : 

I.  EXTERNAL  INDICATIONS,  or   what  have  been  designated  by 


Vlll  PREFACE. 

Marshall  Hall  as  physical  signs  of  disease.  Under  this  head  are 
included  all  those  signs  which  belong  to  the  external  or  visible 
appearance  of  the  patient,  and  over  which  he  has  little  or  no  con 
trol,  as  the  expression  of  countenance,  colour  and  temperature  of 
the  skin,  pulsations  of  the  heart  and  arteries,  respiration,  breath, 
condition  of  the  digestive  and  genito-urinary  organs,  attitude,  ap 
pearance  of  the  eyes,  and  of  the  nose,  lips,  tongue,  mouth,  and 
throat,  the  secretions,  excretions,  surface  of  the  body,  swellings, 
(in  relation  to  size,  hardness,  softness,  elasticity,  fluctuation,  &c.,) 
the  condition  of  the  muscles,  (in  relation  to  contractility,  strength, 
debility,  and  motion,)  the  voice,  mode  of  expression,  and  appear 
ance  of  discharges  from  the  stomach,  intestines,  bladder,  uterus, 
vagina,  nose,  ears,  eyes,  mouth,  and  from  abscesses,  ulcers,  &c. 

These  phenomena  may  always  be  observed  without  any  descrip 
tions  by  the  patient  or  his  friends,  and,  in  many  instances,  without 
the  patient's  consciousness  ;  and,  as  we  have  elsewhere  shown, 
they  often  indicate  with  much  certainty  the  character  of  a  malady. 
In  infants  and  children,  and  adults,  who,  from  injury  or  disease, 
become  incapable  of  communicating  their  sufferings,  they  are  of 
the  utmost  importance,  and  will  frequently  be  sufficient  for  our 
direction  in  the  exhibition  of  remedies. 

II.  PHYSICAL    SENSATIONS,   including  most  of  those  symptoms 
which  are  commonly  described  as  rational  signs  of  disease.  These 
comprise  pains  of  all  descriptions,  weaknesses,  irritations,  oppres 
sions,  obstructions,  and    all  other  uneasy  or  unnatural  feelings, 
and  all  circumstances  connected  with  the  approach,  continuance, 
aggravation,  or  remission  of  the  patient's  sufferings.     For  a  know 
ledge  of  them,  we  must  rely  for  the  most  part  upon  verbal  descrip 
tions  ;  for   the  best  method  of  procuring  which,  with  truth  and 
exactness,  we  refer  to  Hahnemann's  Organon,  pages   125  to  133, 
where  our  venerated  teacher  has  pointed  out  with  great  minuteness 
the  necessary  directions  upon  the  whole  subject  of  such  investiga 
tions. 

III.  MENTAL  AND  MORAL  SYMPTOMS,  including  the  condition  of 
the  mental  faculties,  the  disposition,  temper,  and  all  variations  of 
the  intellectual  and  moral  sentiments,  from  the  normal  standard. 
This  arrangement  has  been  adopted  with  reference  to  convenience 
in  investigation,  and  in  the  selection  of  remedies.     As  some  dis 
eases  are  characterized  by  manifestations  of  one  or  more  of  the  ex 
ternal  indications,  and  others  by  internal  pains,  or  a  perversion  of 
the  mental  and  moral  faculties,  so  different  drugs  develope  corres 
pondences  in  the  organism.     As  it  is  an  object  that  our  remedies 
should  have  as  exact  an  affinity  as  possible  to  the  symptoms,  and 
to  these  alone,  the  advantage  of  this  classification  of  symptoms 
vill  be  readily  perceived. 


PREFACE.  IX 

In  descriptions  of  special  symptoms  created  by  different  reme 
dies,  and  presumed  to  indicate  their  therapeutical  properties,  we 
have  drawn  freely  from  all  reputable  sources,  whether  European, 
or  American.  In  some  instances,  we  have  not  hesitated  to  rely 
upon  drug-symptoms  as  described  by  accurate  practitioners  of  the 
other  school,  in  cases  of  poisoning.  Although  little  confidence  can 
be  placed  in  their  ordinary  observations  upon  the  diseased  organ 
ism  in  relation  to  this  point,  yet  symptoms  are  occasionally  re 
corded  during  the  operation  of  poisonous  doses  upon  the  healthy, 
which  could  riot  well  be  obtained  in  any  other  manner,  and  which 
undoubtedly  form  an  important  addition  to  our  knowledge  of  pure 
drug-symptoms. 

A  difference  of  opinion  exists  in  the  philosophical  school  re 
specting  the  most  suitable  form  for  the  exhibition  of  remedies. 
Some,  entertaining  a  dread  of  medicinal  aggravations,  and  be 
lieving  that  the  minutest  quantity  of  an  appropriate  medicine  is 
sufficient  to  induce  a  curative  reaction,  employ,  for  the  most  part, 
pellets  that  have  been  saturated  with  the  drug.  Others,  having 
less  fear  of  these  aggravations,  and  preferring  to  know  with  cer 
tainty  the  precise  quality  and  quantity  of  their  doses,  make  use  of 
triturations,  given  dry,  in  small  powders,  and  dilutions,  either 
mixed  with  pure  water  or  dropped  on  sugar. 

We  have  preferred  powders  and  dilutions  for  the  following 
reasons  : 

I.  A  large  number  of  medicinal  substances  evaporate  so  quickly, 
that,  after  a  time,  many  of  their  active  particles  must  necessarily 
escape. 

II.  Very  small  quantities  of  many  drugs,  when  exposed  a  few 
weeks  to  the  action  of  the  oxygen  of  the  air,  either  become  en 
tirely  neutralized,  or  so  altered  in  their  properties  as  to  be  no  more 
identical  with  the  original  drug.     On  this  account,  it  is  better  to 
impregnate  larger  quantities  of  the  medium  that  less  surface  may 
be  exposed  to  the  air,  and  thus  to  render  it  certain  that  a  portion 
of  it  retains  particles  of  the  drug  unimpaired. 

III.  The  importance  of  using  our  medicines  in  a  form  that  shall 
be  certain  to  produce  the  requisite  impressions  upon  the  disordered 
structures.     We  deem  it  an  evil  of  much  less  magnitude  to  risk 
the  occasional  induction  of  some  temporary  medicinal  symptoms, — 
thus  being  sure  that  the  remedy  has  reached  the  affected  tissue, — 
than  to  administer  it  in  such  a  form  as  to  produce  no  visible  effects, 
leaving  us  in  doubt  for  a  time  whether  an  impression  has  or  has 
not  been  made  upon  the  affected  parts.     We  do  not  deny  that  pel 
lets,  in  many  instances,  may  prove  entirely  efficient  and  satisfac 
tory,  and  for  non-professional  use,  perhaps  they  are  the  safest ; 


X  PREFACE. 

but  since  we  have  it  in  our  power  to  select  forms  which  arc  certain 
to  contain  the  active  properties  of  drugs,  and  which  enables  us  to 
prescribe  with  greater  exactness,  we  think  that  such  forms  should 
be  generally  adopted  by  the  profession.  We  are  compelled,  there 
fore,  with  deference  to  many  distinguished  cotemporaries,  to  regard 
the  ideas  which  have  so  often  been  promulgated  respecting  medi 
cinal  aggravations,  as  altogether  exaggerated  and  unworthy  that 
serious  consideration  with  which  they  have  often  been  received. 
For  further  observation  upon  this  subject,  we  refer  to  the  chapter 
on  "  Attenuations  of  Drugs  and  Repetitions  of  Doses,"  page  111. 
Finally,  if  some  of  our  opinions  clash  with  those  of  our  homoeo 
pathic  brethren,  we  have  only  to  assure  them  that  our  only  objects 
have  been  to  ascertain  truth,  and  advance  our  science,  and  that  we 
shall  always  be  willing  to  investigate  facts,  and  to  listen  candidly 
to  arguments,  and  whenever  convinced  of  errors,  to  acknowledge 
and  renounce  them. 


ERRATA. 

On  page  221,  tenth  line  from  the  bottom,  for  "  Inclination  is  also  present," 
&c.t  read — "  Inclination  to  vomit  is  also  present,"  <fec. 

On  page  239,  Section  XII.,  heading : — for  "  POPULAR,"  read — "  PAPULAR." 
In  the  Table  of  Contents,  on  page  13,  Chapter  XV  is  omitted,  and  Chapter 
XVI  is  substituted.    Chapter  XVII  should  read  Chapter  XVI. 

On  page  35,  second  line  from  bottom,  read  medendi  for  modendi. 
On  page  93,  sixteenth  line  from  top,  read  attenuations  for  tenuations. 
On  page  94,  first  line,  read  Berzdius  for  Bergelius. 

On  page  200,  tenth  line  from  top,  comma  for  period,  and  small  w  for 
capital  W. 

On  page  305,  24th,  27th,  29th,  30th,  82d,  after  first,  second,  third,  fourth, 
and  fifth,  small  letters  for  capitals. 


HOMEOPATHIC  MEDICINES. 


WM.  RADDE,  322  Broadway,  New- York,  respectfully  informs  the  Homoeo 
pathic  Physicians,  and  the  friends  of  the  System,  that  he  is  the  sole  Agent 
for  the  Leipzig  Central  Homoeopathic  Pharmacy,  and  that  he  has  always  on 
hand  a  good  assortment  of  the  best  Homoeopathic  Medicines,  in  complete 
sets  or  by  single  vials,  in  Tinctures,  Dilutions  and  Triturations ;  also, 
Pocket  Cases  of  Medicines;  Physicians'1  and  Family  Medicine  Chests  to 
Laurie's  Domestic  (60  to  82  Remedies)— EPP'S  (58  Remedies)— BERING'S 
(82  Remedies).— Small  Pocket-Cases,  at  $3,  with  Family  Guide  and  27 
Remedies. — Cases  containing  415  Vials  with  Tinctures  and  Triturations  for 
Physicians.— Cases  with  260  Vials  of  Tinctures  and  Triturations  to  Jahr's 
New  Manual,  or  Symptomen-Codex. — Physicians'  Pocket  Cases  with  60  Vials 
of  Tinctures  and  Triturations.— Cases  from  200  to  300  Vials  with  low  and 
high  dilutions  of  medicated  pellets. — Cases  from  50  to  80  Vials  of  low  and 
high  dilutions,  etc.,  etc.  Homoeopathic  Chocolate.  Refined  Sugar  of  Milk, 
pure  Globules,  etc.  Arnica  Tincture,  the  best  specific  remedy  for  bruises, 
sprains,  wounds,  etc.  Arnica  Plaster,  the  best  application  for  Corns,  Urtica 
urens,  the  best  specific  remedy  for  Burns.  Also,  Books,  Pamphlets,  and 
Standard  Worka  on  the  System,  in  the  English,  French,  and  German  Ian" 
guages, 


CONTENTS. 

PAGE 

Preface,  ...  iii 

CHAPTER  I 
A  glance  at  some  of  the  prominent  medical  doctrines  of  the  past 

and  present,  ...  1 

CHAPTER  II. 
General  observations  on  pathology,       ..  .  7 

CHAPTER  III. 

Doctrines  respecting  a  vital  principle,  nervous  fluid,  dynamic  influ 
ence,  etc.,    ,  ,  ;  •:;.  .  .  22 

CHAPTER  IV. 
Therapeutics,     ,  ,  .  .  ,  .  .  36 

CHAPTER  V. 
Specific  effects  of  morbific  and  remedial  agents,  .  .  40 

CHAPTER  VI. 
Primary  and  secondary  action  of  drugs,  ...  49 

CHAPTER  VII. 
Susceptibilities  of  organs  and  tissues  to  the  influence  of  remedial 

agents,  vastly  greater  in  disease  than  in  health,  .  54 

CHAPTER  VIII. 

Allopathy,  .  61 

CHAPTER  IX. 

HonwBopathy,     .  .  .  .  .  /  86 

CHAPTER  X. 
Attenuations  of  drugs  and  repetitions  of  doses,  .  .  Ill 

CHAPTER  XL 
General  diagnosis,          .  V  ,  ,  .  122 

CHAPTER  XII 
Fevers,  .  .  ,  .  .  ,  .  132 

CHAPTER  XIII 
Causes  of  fever,  .          .,'"''     '.  ../    '-^V.''"  '  "i,J  .  136 

CHAPTER  XIV. 
Intermittent  fever,   '     .         , '.  .        ; ;  >  .  141 

CHAPTER  XVI. 
Yellow  fever,     .  .          •---'-•-        ^  >        ^        '\','^.  •  159 

CHAPTER  XVJL 

Infantile  remittent,         ,.   :  '    .        '    .  :  [.  .  168 

CHAPTER  XVIL 

Continued  fever,  .  .  .  '    /'          172 

CHAPTER  XVIII.  176 

CHAPTER  XIX. 

Hectic  fever,  J ;;  ^  .    -       196 

B 


XIV  CONTENTS. 

CHAPTER  XX. 

Of  the  febrile  cutaneous  diseases,  ,  ,  .  ,  198 

SECTION  1.  Scarlatina. — Scarlet  fever,  .  .  198 

2.  Rubeola.— Measles,        .  .  .  .  207 

"       3.  Variola. — Small  pox,  .  .  .  212 

"      4.  Varicella. — Chicken  pox,  .  .  .  217 

"      5.  Miliaria. — Miliary  fever,   l  ,;f"  218 

6.  Roseola,  .  .  220 

"       7.  Urticaria. — Nettle  rash,      i  *  221 

"       8.  Erysipelas,        .  .  227 

9.  The  Plague,  .  235 

CHAPTER  XXI. 
Of  the  Chronic  Cutaneous  Diseases. 

SECTION  10.  Herpes —Tetter,  ...  236 

"       11.  Pemphigus,      .....  238 

12.  Lichen,      .  ...  239 

"       13.  Scabies,  Psora,  Itch,    ....  240 

"       14.  Ecthyma,  .....  242 

"       15.  Impetigo,         .  .  .  .  .  243 

"       16.  Porrigo,     .  . .  .  .  .  244 

"       17.  Squamous  diseases. — Lepra,    .  .  .  245 

Psoriasis,  ....  246 

Pityriasis,          .        .     .     "        .        '"  .  '       ' \  246 

CHAPTER  XXII. 
Diseases  of  the  Organs  and  Tissues  connected  with  the  Digestive 

System. 

SECTION  1.  Glossitis. — Inflammation  of  the  tongue,  .  247 

"        2.  Tonsilitis. — Quinsy,  .  .  .  248 

"        3.  Parotitis. — Mumps,       .  .  .  .  252 

"        4.  Gastritis,  acute. — Inflammation  of  the  stomach,  253 
"        5.  Gastritis,  chronic. — Chronic  inflammation  of  the 

stomach.  ''".  i     '"  ". ''.        .  .  257 

"        6.  Dyspepsia — Indigestion,          .  .  .  258 

"        7.  Hsematemesis. — Vomiting  of  blood,  .  266 

"        8.  Gastralgia,  Cardialgia. — Neuralgia  of  the  stomach,       267 

"        9.  Enteritis. — Imflammation  of  the  intestines,  268 

"      10.  Acute  mucous  enteritis. — Dysentery,  .  .  270 

"      11.  Peritonitis. — Inflammation  of  the  peritoneum,  278 

"      12.  Colic.  .         .,r. .',         ...  280 

Flatulent  colic,     "M!  "        .  .       .v,»  „  281 

Colica  Pictonum. — Painter's  colic,        .  .  282 

"      18.  Cholera  asphyxia, — Asiatic  cholera,        ^^^  286 

"      14.  Cholera  morbus,       ;T. ,',    frv-  »  295 

"      15.  Diarrhoea,  .  .  297 

"      16.  Haemorrhoids.— Piles,  ....  299 

.  *     17.  Acute  hepatitis. — Inflammation  of  the  liver,  302 

Chr-onic    "  .  .  308 


CONTENTS.  XV 

CHAPTER  XXIII. 
Diseases  of  the  Respiratory  Organs. 

General  observations,      .             .             .             .             .  .             304 

SECTION  1.  Catarrh,  or  Cold,     .             .             .             ,  306 

Influenza,          .             .        .  ^'n        .  .             307 

2.  Cynanche  Trachealis.— Croup,    ••*w«   fl '  .h  308 

"        3.  Bronchitis,        .y     AtttftJ-        .        vzvtlf.  .             316 

"        4.  Pneumonia. — Lung  fever,  .  322 

6.  Pleuritis.— Pleurisy,     .          ,  .-            •  S28 
"        6.  Pertussis. — Whooping  cough,       !* .     •  334 

7.  Asthma,            .             .             .             .' .      ;  /'.'"'':        336 
"        8.  Phthisis  pulmonalis. — Consumption,           .  341 

9.  Cough,             •/  '        i  357 

CHAPTER  XXIV. 
Diseases  of  the  Heart  and  its  Appendages. 

SECTION  1.  Angina  pectoris,                        .         ",•'/.  .             359 

"             Carditis  and  Pericarditis,                .        "  /'  361 

CHAPTER  XXV. 
Diseases  of  the  Brain  and  Nervous  System. 

SECTION  1.  General  observations,                .             .  .             364 

"        2.  Encephalitis. — Inflammation  of  the  brain,  &c.,  371 

"        3.  Ramollissement  du  cerveau. — Softening  of  the  brain,    380 

"        4.  Hydrocephalus. — Dropsy  of  the  brain,  .             381 

"        5.  Epilepsy,           .....  383 

6.  Apoplexy,           I  £3     '   .    :        .            .  387 

"        7.  Paralysis. — Palsy,     £&did    i    *.:>.     •  •*.„',  ,:*;.          392 

"        8.  Mania  &,  potu. — Delirium  tremens,          .  .'.'  394 

"        9.  Insanity,        ,    .             .             ;:.       '.'.  .             397 

Mania,         .             .             .            ;             .  399 

Monomania,       .             .             .             .  .             401 

Dementia,               .             .         •.-..,            .  402 
"      10.  Inflammation  of  the  spinal  marrow  and  its  mem 
branes,          .             .             .         :H-T?>  •             410 
Tetanus,      .           ^^     ,   ,-       ....        .  410 

Hydrophobia,   .        .j-  .        .,   . .   [      ,:.  .             414 

"      11.  Chorea,       ..            ..         ..       ..',,           !  419 

"      12.  Hysteria.— Hysterics,             *.        ^       ,  .             421 

"      13-  Neuralgia,               .             .          ,>             .".  424 

CHAPTER  XXVI. 
Diseases  of  the  Urinary  and  Genital  Organs. 

SECTION  1.  Nephritis. — Inflammation  of  the  kidneys,  .             432 

"        2.  Cystitis. — Inflammation  of  the  bladder,     -V  435 

"        3.  Diabetes,           .             .             .        '-!f  .  .             436 

"        4.  Enuresis. — Incontinence  of  urine,              ^  442 

•'       5.  Suppression  and  retention  of  urine,      .  .            443 

"        C.  Dysuria,     .....  454 


XVI  CONTENTS. 

SECTION  7.  Urinary  Calculi,  ....  454 

"        8.  Urethritis. — Inflammation  of  the  urethra,  465 

9.  Syphilis,  .....  482 

"      10.  Leucorrhoea. — Fluor  albus. — Whites,         ,  496 

"      11.  Amenorrhoea,  .  .  .  .  503 

"      12.  Dysmenorrho3a. — Painful  menstruation,     .  513 

"      13.  Menorrhagia. — Uterine  haemorrhage,    .  .  617 

CHAPTER  XXVII, 
Diseases  of  the  Fibrous  and  Muscular  System. 

SECTION  1.  Acute  rheumatism,       .  .  .  ,  524 

2.  Arthritis.— Gout,  ...  528 

CHAPTER  XXVIII. 

SECTION  1.  Hy drops. — Dropsy,      .  .  ,  .  530 

"        1.  Anasarca. — Cellular  dropsy,  .  .  538 

"        2.  Ascites. — Abdominal  dropsy,  .  539 

"        3.  Hydrothorax. — Dropsy  of  the  chest,  .  542 

"        4.  Ovarian  dropsy,  ....  543 

"        5.  Hydrocele. — Dropsy  of  the  testicle,  .  544 

"        6.  Hydrocephalus. — Dropsy  of  the  brain,  .  381 

CHAPTER  XXIX. 

Chlorosis,  .....  .  555 

CHAPTER  XXX. 

Scrofula,  .  *M  .'• "  ''   .  ,  .  ,  566 

CHAPTER  XXXL 

SECTION  1.  Affections  of  the  eye  and  its  appendages,        .  578 
"        2.  Affections  of  the  tunica  conjunctiva. — Acute  oph 
thalmia,               ,  580 
"        3.  Chronic  ophthalmia,     .             .             .             .  587 
4.  Purulent        «                 .    .  %.-<    ...             .  590 
"        5.  Gonorrhoeal    "                           .«>':                      ,  591 

6.  Scrofulous      "  .         :  ^  -'        .  592 

7.  Granulated  lids,           ....  599 
"        8.  Opacity  of  the  cornea,          .             .             .  600 
"        9.  Affections  of  the  deeper  seated  structures  of  the 

eye. — Inflammation  of  the  cornea,  .  .  601 

"  10.  Iritis,  .  .  .  .  '  ,1  602 

"  11.  Amaurosis,  .  .  .  •'•"*£-  .  605 

"  12.  Hydropthalmia. — Dropsy  of  the  eye,  .  611 

"  13.  Cataract,  .  .  ^_  ^  :  .  614 

"  14.  Fungus  haematodes,  and  cancer  of  the  eye,  617 
"  15.  Affections  of  the  appendages  of  the  eye. — Hordeo- 

lum. — Stye,  .  'i  .  .  621 

"  16.  Entropium  and  ectropium. — Inversion  and  eversion 

of  the  eyelids,  .  .  "•,*.  .  622 

"  17.  Fistula Lachrymalis,  .  ...  •  ^q  .  623 


HOMEOPATHIC 

THEORY  AND  PRACTICE  OF  MEDICINE. 


CHAPTER  I. 

A  GLANCE  AT  SOME  OF  THE  PROMINENT  MEDICAL  DOC 
TRINES  OF  THE  PAST  AND  PRESENT. 

IN  tracing  the  history  and  philosophy  of  medical  sci 
ence,  from  the  earliest  periods  to  the  present  time,  we 
are  presented  with  a  singular  spectacle.  Commencing 
with  those  pioneers  in  medical  art,  the  Asclepiades, 
we  find  that  there  has  been  a  constant  series  of  revo 
lutions,  in  both  the  theory  and  practice  of  their  noble 
profession,  down  to  the  present  day.  Hypotheses  have 
been  advanced  and  theories  established  by  one  genera 
tion,  to  be  admired  and  followed  for  a  time,  only  to  be 
overthrown  and  superseded  by  others,  which,  in  their 
turn,  were  doomed  to  a  similar  fate.  Each  generation 
has  looked  upon  the  generations  which  have  passed, 
commiserating  their  errors  and  delusions,  while  the 
present  doctrines  have  been  complacently  regarded 
as  correct,  and  destined  to  stand  unchanged  before 
the  investigations  and  discoveries  of  all  future  ages. 

The  grand  cause  of  all  this   may  be  found  in  the 
fact  that  these  theories  have  been  based  upon  con 
jecture.     Certain  conditions  have  been  assumed,  and 
1 


2  GLANCE    AT    THE    PROMINENT    MEDICAL 

certain  states  of  the  system  supposed  to  exist,  without 
any  real  grounds  for  such  assumptions  or  suppositions. 
Instead  of  bringing  facts  to  bear — facts  susceptible  of 
demonstration — and  raising  thus  their  theories  on  a  solid 
foundation,  each  writer  has  given  himself  to  subtle 
and  abstruse  reasonings,  taking  for  his  data  conjec 
tural  agencies  and  false  positions  in  relation  to  the 
structures  and  functions  of  the  economy. 

Notwithstanding,  however,  the  great  errors  which 
most  of  these  doctrines  have  contained,  the  world  has 
derived,  from  their  promulgation,  many  useful  hints  and 
valuable  suggestions.  Indeed,  as  far  as  close  and  ac 
curate  observation  of  the  phenomena  of  disease  is  con 
cerned,  the  ancients  were  by  no  means  inferior  to  the 
moderns.  Nor  should  posterity  depreciate  their  labours 
or  detract  from  their  fame  :  for  when  we  bear  in  mind 
the  paucity  of  anatomical  and  chemical  knowledge, 
and  the  numerous  disadvantages  under  which  the  ear 
lier  writers  laboured,  we  cannot  but  admire  their  per 
severing  industry,  and  behold  with  astonishment  the 
amount  of  real  truth  which  they  discovered.  Whe 
ther  the  moderns,  with  all  their  improvements  in 
other  sciences,  have  done  as  much  for  the  advance 
ment  of  medicine,  is  a  question  which  we  shall  leave 
for  others  to  decide. 

In  contemplating  the  earlier  history  of  medical  doc 
trines,  we  shall  not  fail  to  observe  that  many  of  the 
pathological  opinions  of  Hippocrates  have  prevailed 
down  to  a  very  late  period.  Although  the  "  father  of 
medicine"  drew  largely  upon  his  imagination,  in  es 
tablishing  the  humoral  pathology,  instead  of  trusting 
exclusively  to  known  truths,  yet  so  great  was  the  in 
fluence  which  he  acquired  in  the  medical  world,  that 
almost  implicit  reliance  was  placed  on  his  views,  both 
pathological  and  therapeutical,  for  many  centuries. 
Unfortunately  for  mankind,  many  of  his  most  valuable 
ideas  upon  these  subjects  have  been  unappreciated 
and  almost  entirely  neglected.  During  the  time  of 
Hippocrates,  and  even  preceding  his  day,  the  import 
ance  of  physical  education  was  much  dwelt  upon,  not 
only  as  a  means  essential  for  the  perfect  development 
and  health  of  the  body,  but  for  the  strength  and  activity 
of  1hf  intellect.  To  Herodicus,  who  appears  to  have 


DOCTRINES  OF  THE  PAST  AND  PRESENT.          3 

been  the  inventor  of  the  gymnastic  treatment,  ancient 
Greece  was  indebted  for  the  superior  physical  culture 
which  her  sons  enjoyed,  and  which  conduced  so  ma 
terially  to  her  glory.  The  principals  of  these  gymnas 
tic  schools  were 'men  skilled  in  medicine,  and  their 
efforts  were  exerted  to  secure  for  their  pupils  the 
highest  possible  state  of  physical  and  mental  vigour. 
Let  us  endeavour  to  emulate  the  practice  of  these 
wise  men,  in  this  now  unappreciated  branch  of  educa 
tion,  and  thus,  by  perfecting  the  development  of  the 
body,  in  accordance  with  the  dictates  of  nature,  secure 
to  mankind  more  uninterrupted  health  and  a  higher 
degree  of  intellectual  power. 

For  some  centuries  subsequent  to  the  death  of  Hip 
pocrates,  few  real  discoveries  were  made  in  medical 
science.  Although  several  men  like  Praxagoras  of 
Cos,  Chrysippus,  Herophilus,  and  Asclepiades,  ad 
vanced  new  hypotheses,  and  introduced,  from  time  to 
time,  many  innovations  in  practice,  yet,  in  the  main, 
they  were  all  advocates  of  the  humoral  pathology* 
About  a  century  before  Christ,  however,  Themison, 
the  founder  of  the  methodic  sect,  made  his  appear 
ance.  Discarding  the  doctrines  of  Hippocrates,  he  ad 
vanced  the  opinion  that  all  diseases  arise  from  two 
morbid  states  of  the  system,  which  are  contrary  to 
each  other — a  state  of  constriction  and  a  state  of  re 
laxation.  To  these  he  afterwards  added  a  third  state, 
compounded  of  the  two  former,  which  he  termed  the 
mixed  state.  The  remedies  which  he  considered  ap 
plicable  to  these  different  conditions  were  relaxants 
and  astringents. 

After  Themison  came  the  classic  Celsus.  Without 
wedding  himself  to  any  particular  theory,  he  made  ju 
dicious  selections  from  the  doctrines  of  his  predeces 
sors,  and  thus  instituted  his  method  of  practice.  He 
conceived  that  diseases  have  a  direct  tendency  to  cure 
themselves,  and  that  the  measures  of  the  physician 
should  be  so  directed  that  the  efforts  of  nature  are  not 
interfered  with,  and  that  the  remedies  applied  shall  be 
those  which  experience  has  shown  to  have  a  tendency 
to  aid  the  operations  of  nature.  He  classified  the  dif 
ferent  species  of  fever,  and  discarded  the  doctrine  of 
Hippocrates  in  regard  to  critical  days :  and  by  clearing' 


4  GLANCE    AT    THE    PROMINENT    MEDICAL 

away  many  of  the  absurdities  of  his  predecessors,  con 
tributed  much  to  simplify  and  correct  the  prevailing 
doctrines.  The  expectant  method  of  practice  owes  its 
origin  to  this  distinguished  man. 

After  Celsus,  a  few  bright  stars  shone  out  in  the 
medical  firmament,  shedding  their  rays  of  knowledge 
over  the  world,  until  the  second  century  after  Christ, 
when  all  were  extinguished  ;  and  medicine,  in  common 
with  the  other  sciences,  slumbered  through  the  dark 
ages.  Amongst  those  who  were  most  conspicuous 
in  this  earlier  period,  may  be  mentioned  Aretseus, 
Musa,  Scribonius  Largus,  Andromachus,  Rufus  the 
Ephesian,  and,  finally,  Galen.  These  were  all  advo 
cates  of  the  humoral  pathology,  but  to  the  latter  must 
be  awarded  the  palm,  not  only  for  the  able  manner  in 
which  he  amplified  and  explained  the  doctrines  of 
Hippocrates,  but  for  the  immense  number  of  practical 
facts  which  he  gave  to  science. 

At  the  commencement  of  the  sixteenth  century,  the 
attention  of  physicians  began  to  be  more  particularly 
directed  to  the  study  of  anatomy  and  chemistry,  for 
the  purpose  of  elucidating  the  phenomena  of  disease, 
and  the  operations  of  medicines.  About  this  time 
appeared  Paracelsus,  who  boldly  denounced  all  previ 
ous  theories,  and  ushered  into  the  world  a  new  doc 
trine,  founded  upon  chemical  views.  This  celebrated 
person  taught  that  all  living  bodies  were  composed  of 
the  same  elements  as  other  kinds  of  matter,  and  were 
subject  to  the  same  chemical  laws.  These  elements 
were  supposed  to  be  sulphur,  mercury,  and  salts;  upon 
a  due  proportion  of  which  the  health  of  the  body  was 
believed  to  depend,  and  any  variation  from  this  pro 
portion  to  constitute  a  cause  of  disease.  He  supposed 
that  a  certain  intelligence  which  he  calls  "  archeus" 
located  in  the  stomach,  presides  over  these  elements, 
and  causes  their  good  qualities  to  be  assimilated  to  the 
body,  and  the  noxious  principles  to  be  rejected.  This 
"  archeus,"  like  the  "  phusis"  of  Hippocrates,  served 
an  excellent  purpose  in  filling  the  gap  whenever  no 
plausible  explanation  could  be  found  for  the  establish 
ment  of  his  absurd  propositions. 

To  Paracelsus,  however,  is  due  the  credit  of  having 
first  suggested  the  true  therapeutical  principle,  to  give 


DOCTRINES  OF  THE  PAST  AND  PRESENT.          5 

those  drugs  for  the  cure  of  disease,  which  in  health 
give  rise  to  a  train  of  symptoms  similar  to  those  of 
the  malady.  But  the  numerous  erroneous  notions 
which  he  entertained  respecting  physiology. pathology, 
and  the  specific  effects  of  medicines,  prevented  the 
practical  development  of  the  magnificent  idea  which 
his  mind  had  conceived. 

The  next  reformer  of  note  is  Sydenham,  who  flourish 
ed  about  the  middle  of  the  seventeeth  century.  He  also 
was  a  humoralist,  and  indulged  largely  in  hypotheses; 
but  he  contributed  much  to  the  advancement  of  science. 
Until  this  period,  the  idea  had  prevailed  that  disease 
consisted  in  an  altered  state  of  the  fluids.  Whether 
disciples  of  Hippocrates  and  Galen,  chemists,  mechani 
cians,  or  metaphysicians,  all  believed  in  the  humoral 
pathology.  After  Sydenham,  however,  Baglivi  and 
Hoffman  appeared,  and  effected  a  change  of  an  impor 
tant  character.  With  Baglivi  originated  the  doctrine 
that  all  morbid  changes  commenced  in  the  solids,  and 
that  the  fluids  were  acted  upon  secondarily.  Hoffman 
embraced  the  views  of  Baglivi,  but  enlarged  upon 
them,  and  introduced  the  hypothesis  that  the  "  muscu 
lar  fibre  is  endowed  wTith  a  certain  degree  of  tone, 
which  constitutes  its  healthy  state ;  but  from  various 
circumstances,  this  action  may  be  morbidly  impaired, 
or  increased,  on  the  one  hand,  so  as  to  generate  spasm, 
or  morbidly  diminished,  until  it  arrives  at  the  opposite 
condition  of  atony." 

Contemporary  with  Hoffman,  was  Stahl,  who  ad 
vanced  the  idea  of  the  existence  of  an  independent 
principle,  which  pervades  the  body,  affording  to  it  its 
vital  energies,  and  upon  which  the  operations  of  the 
economy  depend.  Not  having  acquired  an  accurate 
knowledge  of  the  chemical  operations  which  are  con 
stantly  going  forward  in  the  body,  or  any  just  ideas  in 
regard  to  the  phenomena  of  life,  it  is  not  surprising 
that  this  great  man  confounded  the  operations  of  the 
intelligence  with  the  vital  principle.  But  however 
erroneous  may  have  been  many  of  the  ideas  of  Stahl, 
his  writings  contain  some  entirely  new  and  very  valu 
able  truths. 

Stahl  supposed  that  the  superintending  principle, 
the  "  anima"  presides  over  the  operations  of  the  living 


6  GLAXCE    AT    THE    PROMINENT  MEDICAL,  ETC. 

organism,  having  no  exclusive  location,  but  pervad 
ing  every  part  of  the  body,  causing  motion  in  the  or 
gans  of  motion,  sensation  in  the  organs  of  sense,  and 
all  the  phenomena  of  life,  by  a  direct  operation  or  in 
fluence  upon  each  particular  part.  Had  he  not  been 
imbued  with  the  prevailing  absurdities  respecting  a 
"  vital  principle,"  a  "nervous  fluid,"  a  "  dynamic  in 
fluence,"  &c.,  this  idea  might  have  led  to  splendid  re 
sults  ;  but  instead  of  recognising  in  this  anima,  the 
soul,  or  intelligence,  he  confounded  it  with  certain  sup 
posed  spiritual  or  vital  properties  which  pertained 
alone  to  the  body,  and  which  he  supposed  were  anni 
hilated  on  the  death  of  the  body.  Elsewhere  we  shall 
again  allude  to  this  subject. 

The  brilliant  intellect  of  Stahl  also  distinctly  recog 
nised  the  truth  of  similia  similibus  cur  ant  ur,  and  point 
ed  out  its  advantages  over  the  then  universal  law  of 
cure,  contraria  contrariis  opponenda.  Had  he,  or  Par 
acelsus  before  him,  adopted  the  course  of  Hahnemann 
in  experimenting  with  drugs,  in  health  and  in  disease, 
and  by  this  means  accumulated  a  sufficiency  of  facts — 
the  incontrovertible  arguments  in  sustaining  any  theory 
— homoeopathy  would  long  since  have  been  the  only 
system  of  medicine.  Both  these  reformers  were  pos 
sessed  of  gigantic  intellects — genius,  indeed,  of  the  high 
est  order — and  the  most  exalted  moral  courage,  which 
enabled  them  to  disregard  the  ex-cathedra  dogmas 
of  antiquity ;  but  they  lacked  that  patient  and  self- 
sacrificing  devotion  in  pursuit  of  facts,  and  that  un 
bounded  benevolence  and  love  of  mankind,  which  so 
essentially  characterized  the  career  of  Hahnemann. 
To  the  latter  therefore  should  be  rendered  all  the 
credit  which  attaches  to  this  school  of  medicine. 

Since  the  time  of  Stahl,  physicians  have  formed 
their  therapeutical  opinions  mostly  by  observation  of 
phenomena,  both  in  regard  to  the  action  of  the  organs 
and  the  effects  of  remedies.  The  rapid  advancement  in 
the  knowledge  of  anatomy,  physiology,  pathology  and 
chemistry,  has  conduced  much  to  call  into  existence 
better  ideas  in  the  entire  science,  and  to  do  away  with 
the  mass  of  hypothetical  rubbish  which  had  been 
accumulating  for  so  many  centuries.  From  the  age 
of  Stahl  each  man  began  to  rely  more  upon  his  own 


GENERAL    OBSERVATIONS    ON    PATHOLOGY.  7 

observation  in  forming  his  views ;  and  the  influence 
of  ancient  names  and  ancient  doctrines  became  less 
powerful.  In  the  list  of  innovators  may  be  placed 
the  names  of  Haller,  Sauvages,  the  "  father  of  Noso 
logy,"  Brown,  Darwin,  Bichat,  Morgagni,  Broussais, 
and  many  other  writers  with  whose  doctrines  we  are 
all  familiar. 

We  have  thus  briefly  alluded  to  a  few  of  the  more 
eminent  men  of  the  past,  not  to  enter  into  an  exposition 
of  their  peculi  ar  doctrines,  but  to  illustrate  the  numerous 
changes  which  have  occurred  in  the  theory  and  prac 
tice  of  physic.  And  how  few  of  the  views  of  all 
these  great  men  are  at  this  day  deemed  worthy  of  con 
sideration  !  How  little  have  modern  writers  been  able 
to  profit  by  this  labour  of  centuries,  in  erecting  a  true 
and  uniform  system  of  pathology  and  therapeutics ! 
Indeed,  Allopathy  at  this  moment,  is  entirely  destitute 
of  any  recognised  theory.  Her  followers,  for  the  most 
part,  are  eclectics ;  each  man,  like  Celsus  of  old, 
selecting'  one  idea  here  and  another  there,  as  best  suits 
his  taste.  Better  far  would  it  be  for  mankind,  if  they 
would  follow  their  illustrious  examplar  still  further, 
and  trust  more  to  the  efforts  of  nature,  and  less  to 
the  violent  and  uncertain  effects  of  their  applications. 


CHAPTER  II. 

GENERAL  OBSERVATIONS  ON  PATHOLOGY. 

We  shall  now  lay  before  our  readers  some  views  in 
regard  to  general  pathology  and  inflammation,  which 
we  trust  may  conduce  somewhat  to  the  advancement 
of  our  science.  In  offering  these  opinions  to  the 
public,  we  have  not  the  presumption  to  suppose  that 
we  are  about  establishing  any  new  theory  ;  but  if  we 
succeed  in  throwing  some  new  light  upon  the  compli 
cated  operations  of  the  human  economy,  our  end 
will  be  attained. 

We  hold  that  it  is  the  province  of  the  physician  not 
only  to  cure  diseases,  but  to  point  out  the  surest  me 
thods  of  preventing  them.  In  order  to  do  this  sue- 


8  GENERAL    OBSERVATIONS 

cessfully,  it  is  necessary  that  he  appreciate  those 
conditions  which  constitute  health,  so  as  to  guard 
against  the  numerous  causes  of  its  disturbance.  In  all 
living  bodies,  certain  states  are  essential  to  this 
condition.  The  most  important  of  these  states  are — 
1st,  a  soundness  of  the  organs  and  tissues  ;  2d,  an 
adequate  supply  of  nutritious  food  ;  3d,  pure  air,  that 
the  blood  in  the  lungs  may  be  oxygenated ;  4th,  a 
calm  activity  of  mind,  so  that  the  requisite  stimulus  of 
the  intelligence  shall  produce  its  peculiar  effects 
upon  all  parts  of  the  body ;  5th,  an  avoidance  of  the 
various  causes  which  debilitate,  overtask,  or  in  any  way 
impair  the  integrity  of  the  nervous  or  muscular  sys 
tems  ;  6th,  the  practice  of  those  means  which  are  cal 
culated  to  ensure  the  due  performance  of  all  the 
functions,  as  exercise,  amusements,  the  cultivation  of 
a  cheerful  temper,  bathing,  and  moderation  and  regu 
larity  in  all  the  habits  of  life.  Thus  the  functions 
will  be  performed  in  a  certain  definite  and  uniform 
manner,  the  requisite  equilibrium  between  the  supply 
and  waste  of  the  body  be  retained,  and  that  state  se 
cured  by  which  health  is  constituted. 

It  should  be  firmly  impressed  upon  the  mind, 
that  the  important  offices  of  respiration,  circulation, 
digestion,  assimilation,  absorption,  secretion,  &c., 
are  dependent  upon  the  chemical  action  which  is  con 
stantly  going  forward  within  the  body,  between  the 
elements  of  the  tissues  and  the  inspired  oxygen  on 
one  hand,  and  a  uniform  supply,  through  the  nerves, 
of  spiritual  stimuli  on  the  other.  When  these  ele 
ments  are  supplied  in  due  proportion,  from  the  food 
and  the  air,  and  no  unnatural  or  injurious  cause  acts 
on  the  system,  health  must  result. 

But  if  the  quantity  of  oxygen  absorbed  to  unite 
with  the  elements  of  the  tissues,  is  insufficient  to  gene 
rate  the  natural  amount  of  animal  heat  and  motion,  or 
if  the  strength  of  one  or  more  of  the  tissues  becomes, 
from  any  cause,  so  impaired  as  to  be  incapable  of 
offering  the  requisite  resistance  to  the  oxygen  of  the 
blood,  disease  ensues.  In  the  latter  case,  the  impaired 
state  of  the  diseased  structure  does  not  offer  sufficient 
contractile  power  to  prevent  the  intromission  of  red 
globules  into  those  parts  which,  in  the  normal  state, 


ON  PATHOLOGY.  *J 

contain  only  the  ordinary  products  of  the  transforma 
tions  of  the  tissues.  The  result  is,  that  the  pores  are 
obstructed,  the  sweat  is  retained  in  the  system — thus 
affording  additional  fuel  for  combustion,  with  the  oxy 
gen  of  the  blood,  and  from  the  unnatural  irritation 
which  it  causes,  giving  rise  to  accelerated  respiration, 
circulation,  and  the  other  phenomena  of  fever.  If  the 
resisting  power  of  the  tissues  continues  impaired  for  a 
length  of  time,  and  the  oxygen  continues  to  act  as 
usual,  disorganization  must  follow. 

It  has  been  proved  that  32|  ounces  of  oxygen  enter 
the  system  of  an  adult  daily,  the  whole  of  which 
goes  into  combination  with  the  elements  of  the  food, 
and  is  thrown  off  through  the  lungs  and  skin  in  the 
form  of  carbonic  acid  and  watery  vapour. 

The  same  quantity  of  carbon  and  nitrogen  is  sup 
plied  to  the  blood  from  the  elements  of  the  food,  to 
reproduce  the  organs,  which  is  lost  by  the  waste  or 
exercise  of  the  functions.  According  to  Liebig,  "  the 
quantity  of  oxygen  absorbed  determines  the  amount 
of  food  necessary  to  be  assimilated." 

If  then  the  food  be  properly  digested  and  assimila 
ted,  a  due  quantity  of  pure  air  be  respired,  and  the 
normal  integrity  of  the  organs  remain  unimpaired, 
all  the  structures  will  act  with  uniformity,  and  a 
healthy  equilibrium  will  result.  To  ensure  a  con 
tinuance  of  such  a  condition,  it  is  not  only  necessary 
to  avoid  all  of  those  causes  which  are  directly 
capable  of  disturbing  this  complicated  series  of  func 
tions,  but  to  make  use  of  those  means  which  tend  to 
invigorate  the  system,  and  aid  nature  in  her  opera 
tions.  In  civilized  life,  these  sources  of  disturbance 
are  almost  innumerable  ;  but  in  the  progress  of  this 
work,  we  shall  endeavour  to  point  out  some  of  the 
more  prominent,  and  show  in  what  manner  they 
operate  in  causing  disease. 

In  the  healthy  state  of  the  system,  certain  structures 
possess  the  power  of  effectually  excluding  the  red 
globules  of  the  blood ;  thus  preventing  a  too  great 
change  of  matter,  which  an  event  of  this  kind  would 
inevitably  produce.  This  power  is  dependent,  for  its 
normal  action,  upon  the  presence  of  two  conditions, 
viz.,  an  adequate  amount  of  resisting  power  in  the 

1* 


10  GENERAL    OBSERVATIONS 

muscular  fibres,  which  modern  writers  term  contrac 
tility,  and  an  unimpaired  state  of  the  nerves,  in  order 
that  the  intelligence  may  communicate  with  the  ex 
treme  parts,  and  thus  afford  the  muscular  fibres  an 
additional  stimulus  or  power  of  resistance.  This  sti 
mulus,  of  which  the  nerves  are  the  conductors,  is  an 
agent  of  immense  importance  in  modifying  and  altering 
the  functions  of  the  structures.  In  the  normal  state, 
its  effects  are  apparent  during  the  various  perceptions 
and  emotions  which  are  constantly  agitating  us. 
When  these  two  properties  remain  unimpaired,  every 
office  must  be  duly  performed. 

It  is  true  that  the  muscular  or  the  nervous  systems 
may  be  tasked,  for  a  short  period,  without  detriment ; 
provided,  that  a  corresponding  degree  of  rest  be 
allowed,  for  the  weakened  energies  to  be  restored  to 
their  natural  state.  This  is  witnessed  in  severe  bodily 
or  mental  labour  ;  the  immediate  effects  of  which  are, 
fatigue,  lassitude,  and  diminished  muscular  and 
nervous  energy.  If  this  be  succeeded  by  a  due  allow 
ance  of  sleep,  the  waste  of  force  is  repaired,  and 
the  body  resumes  its  healthy  tone.  If,  however,  this 
labour  be  continued  beyond  a  certain  point,  and  the 
requisite  quantity  of  rest  be  withheld,  the  capillaries 
lose  their  vitality,  become  incapable  of  resisting  the 
entrance  of  red  blood,  and  inflammation,  with  fever, 
is  the  consequence. 

Indeed,  it  may  be  laid  down  as  a  general  rule,  that 
most  of  those  causes  which  are  capable  of  producing 
disease,  act  by  impairing  the  muscular  and  nervous 
force  of  the  tissues  to  such  an  extent  as  to  render  them 
incapable  of  excluding  the  red  globules.  We  know 
that  these  globules  are  charged  with  oxygen,  and 
that  this  gas,  when  in  contact  with  parts  of  which  the 
elements  consist  of  carbon  and  hydrogen,  must  effect 
chemical  changes.  It  matters  not  whether  these 
changes  are  produced  within  the  body  or  in  the  air ; 
the  results  are  in  both  instances  the  same. 

It  has  been  proved  by  the  experiments  of  Bichat, 
Buniva,  and  Philip,  that  the  capillaries  of  a  healthy 
living  animal  effectually  resist  the  introduction  of 
tluids,  even  when  a  powerful  syringe  is  used  ;  but  as 
the  energies  of  the  animal  sink,  they  gradually  lose 


ON    PATHOLOGY.  11 

their  power  of  resistance,  and  allow  the  fluid  to  pass 
into  them  like  "  passive  and  yielding  tubes."  From 
these  experiments  it  is  evident  that  the  capillaries  are 
the  first  to  lose  their  vitality,  since  the  large  arteries 
have  been  observed  to  retain  their  contractile  power 
some  hours  after  death.  Thus  it  is  that  the  first 
manifestations  of  disturbing  causes  are  upon  the 
surface,  in  the  condition  of  chills,  succeeded  in  a  short 
time  by  unnatural  heat  and  inflammation.  "  Push 
into  the  aorta  of  a  living  animal,  by  means  of  a  sy 
ringe,  different  fine  fluids,  and  you  will  never  see  them 
fill  the  capillary  system,  or  issue  by  the  exhalents ; 
but  when  the  experiment  is  performed  soon  after  the 
death  of  the  animal,  the  fluid  will  pass  readily  into 
the  serous  capillaries,  and  pass  out  by  the  exhalents, 
excretory  ducts,  &c." — (Bichat.) 

From  the  above  facts  it  is  evident,  that  whenever 
the  integrity  of  the  extreme  parts  becomes  impaired, 
the  introduction  of  the  red  globules  is  permitted, 
which,  according  to  chemical  laws,  must  give  rise  to 
increased  evolution  of  heat,  inflammation  and  thick 
ening  of  the  capillaries,  and  consequent  obstruction  to 
the  passage  of  the  excretions.  The  retention  of  the 
products  of  the  combustion  of  the  oxygen  of  the  blood 
and  the  elements  of  the  food,  is  an  additional  source 
of  disturbance.  These  irritating  substances  induce 
accelerated  respirations,  in  order  that  sufficient  oxygen 
may  be  absorbed  to  neutralize  them,  and  thus  cause 
exaltation  of  temperature,  increased  activity  of  the 
organs,  and  the  phenomena  of  fever. 

In  all  our  pathological  inquiries,  it  is  of  the  first 
importance  that  we  have  a  distinct  appreciation  of 
the  laws  which  produce  and  regulate  the  phenomena 
of  life,  and,  as  far  as  practicable,  of  the  influence  of 
external  agents  in  modifying  these  phenomena. 

First,  the  primary  source  of  animal  heat  and  mo 
tion,  is  the  chemical  action  which  takes  place  in  the 
lungs.  Secondly,  when  the  blood  arrives  at  the  ex 
treme  vessels,  other  and  important  chemical  changes 
occur  between  the  oxygen  of  the  blood  and  the  ele 
ments  of  the  tissues,  giving  rise  to  a  great  amount  of 
caloric  and  motion.  Now  as  the  combustion  at  the 
lungs  is  the  principal  cause  of  propelling  the  blood 


12  GENERAL    OBSERVATIONS 

through  the  arteries  into  the  capillaries — so  it  is  pro 
bable  that  the  combustion  which  occurs  between  the 
oxygen  of  the  red  globules,  and  the  elements  of  the 
changed  tissues  at  the  extreme  vessels,  is  the  princi 
pal  source  of  the  motive  power  which  forces  the 
blood  back  through  the  veins  to  the  heart  and  lungs. 
There  can  be  no  chemical  change  without  the  evolu 
tion  of  heat,  no  heat  without  expansion,  and  no  ex 
pansion  without  developing  motive  power.  We  are 
obliged  to  reject  the  doctrine  that  the  blood  is  brought 
back  through  the  veins  to  the  heart,  by  a  kind  of  suc 
tion,  which  this  organ  exercises  on  account  of  the 
vacuum  which  constantly  occurs  within  its  walls  ;  for 
if  this  motive  force  is  all  located  at  the  heart,  there 
is  no  way  of  accounting  for  the  expenditure  of  the 
large  amount  of  motive  power  constantly  generated  at 
the  extreme  points.  We  see  two  parts  of  the  body 
where  combustion  is  constantly  occurring,  viz.,  the 
lungs  and  the  extreme  vessels ;  and  when  we  remember 
that  the  laws  which  govern  chemical  action,  whether 
in  the  body  or  the  air,  are  similar,  we  can  appreciate 
the  probable  force  which  must  be  produced  at  these 
extremities. 

Since  then  the  animal  heat,  motive  force,  &c.,  are 
generated  principally  at  the  lungs,  and  in  the  capil 
laries,  it  is  evident  that  any  cause  which  can  disturb 
the  healthy  operation  of  either  of  these  important 
parts  must  produce  immediate  and  serious  disturbance 
throughout  the  whole  system. 

The  agents  capable  of  inducing  disease  here,  are 
numerous  and  dissimilar. 

In  hot  climates,  the  atmosphere  being  highly  rare 
fied,  a  less  volume  of  oxygen  is  absorbed  at  each  in 
spiration,  and  consequently  a  less  quantity  afforded  to 
enter  into  combination  with  the  carbon  of  the  system. 
On  this  account  we  observe  a  greater  prevalence  of 
liver  and  bilious  affections  in  torrid  than  in  temperate 
latitudes.  Unless  extreme  care  be  taken  to  avoid 
animal  food,  liquors,  and  other  articles  which  produce 
a  large  amount  of  carbon,  this  element  will  so  abound, 
that  the  rarefied  air  which  is  inhaled  will  be  wholly 
inadequate  to  effect  those  changes  which  serve  to  re 
tain  the  equilibrium  between  the  supply  and  waste. 


UN    PATHOLOGY.  13 

from  the  transformations  of  tissues.  Here,  a  greater 
quantity  of  the  elements  of  nutrition  are  usually  assi 
milated  than  the  inspired  oxygen  can  decompose. 
This  excess  of  carbon  and  hydrogen  being  retained, 
the  nervous  and  muscular  force  of  the  tissues  become 
relaxed  and  enfeebled,  so  that  from  slight  exciting 
causes,  diseases  of  a  bilious  or  congestive  character 
are  engendered. 

We  have  said  that  the  same  quantity  of  carbon 
and  hydrogen  should  be  supplied  to  the  blood  from 
the  elements  of  the  food,  to  reproduce  the  organs, 
which  is  lost  by  the  waste  or  exercise  of  the  functions. 
That  which  is  not  acted  upon  by  the  oxygen  in  the 
lungs  and  at  the  skin,  is  taken  up  by  the  veins,  and 
carried  to  the  liver,  \vhich  separates  those  substances 
(carbon,  soda,  &c.,)  incapable  of  reproducing  the 
tissues,  and  finally  depositing  them  in  the  gall-blad 
der  in  the  form  of  bile.  When  the  amount  of  bile 
exceeds  the  retentive  capacity  of  the  gall-bladder, 
the  surplus  must  run  over,  and  a  large  portion  of  it 
be  conveyed  into  the  system,  thus  impairing  the  integ 
rity  of  the  tissues,  and  laying  the  foundation  of  those 
diseases  incident  to  equinoctial  latitudes. 

In  cold  climates,  a  state  of  things  the  reverse  of 
this  ensues.  Here,  the  air  being  highly  conden 
sed,  a  large  volume  of  oxygen  is  absorbed  at  each 
inspiration,  to  combine  with  the  carbon  of  the 
system,  and  thus  generate  sufficient  caloric  to  com 
pensate  for  that  which  is  abstracted  by  external  cold. 
For  this  condition,  all  causes  which  can  impair  the 
normal  state  of  the  digestive  organs  must  be  avoided, 
in  order  that  a  sufficient  amount  of  carbon,  &c.,  may  be 
assimilated,  to  combine  with  the  oxygen  and  secure 
the  healthy  equilibrium.  The  greater  the  exposure 
to  external  cold,  the  larger  must  be  the  supply  of 
food  and  oxygen  to  make  up  for  the  loss  of  heat. 

Cold,  acting  unduly  upon  the  external  parts  of  the 
body,  produces  a  train  of  symptoms  similar  to  those 
caused  by  miasmata  and  other  noxious  exhalations  when 
inhaled.  The  first  effects  in  either  instance,  are  to  im 
pair  the  energy  of  the  extreme  vessels,  inducing  constric 
tion  and  chills,  to  be  succeeded  by  diminished  resisting 


14  GENERAL    OBSERVATIONS 

power,  and  other  phenomena  which  characterize  in 
flammation. 

The  increased  action  of  the  circulatory  vessels 
which  usually  follows  the  chills,  has  been  referred  by 
some  writers  to  the  stimulus  of  a  greater  volume  of 
blood  being  thrown  upon  these  organs  than  is  natural, 
and  the  increased  heat  which  accompanies  this  exal 
tation  as  a  result  of  the  action  itself.  No  greater 
error  than  this  could  be  promulgated,  for  the  entire 
source  of  animal  heat  is  chemical  action,  and  all  of 
the  involuntary  motions  must  bear  a  direct  ratio  to 
this  evolution  of  heat.  If  the  skin,  lungs,  brain,  or 
any  other  part,  becomes  from  any  cause  incapa 
ble  of  affording  the  normal  resistance  to  the  oxygen 
which  is  constantly  brought  into  contact  with  it, 
an  augmented  chemical  action  must  occur  in  it, 
with  the  invariable  concomitants,  increased  heat,  con 
gestion,  and  fever. 

"  If  a  given  part  of  the  body  is  acted  upon  by  con 
tinued  and  intense  cold,  while  the  other  parts  retain 
their  natural  temperature,  there  occurs,  after  a  time, 
in  consequence  of  the  loss  of  heat,  an  accelerated 
change  of  matter  in  the  cooled  parts.  The  momen 
tum  of  the  force  of  the  vitality,  in  the  parts  which 
are  not  cooled,  is  expended,  as  before,  in  mechanical 
motion  ;  but  the  whole  action  of  the  inspired  oxygen 
is  exerted  on  the  cooled  part.  In  the  cooled  'part 
of  the  bod}',  the  living  tissues  offer  a  less  resistance 
to  the  chemical  action  of  the  inspired  oxygen  :  the 
power  of  the  oxygen  to  unite  with  the  elements  of 
the  tissues,  is,  at  this  part,  exalted.  In  the  cooled 
part,  the  change  of  matter,  and  with  it  the  disengage 
ment  of  heat,  increases  ;  while  in  other  parts  of  the 
body,  the  change  of  matter  and  the  liberation  of  heat, 
decrease.  But  when  the  cooled  part,  by  the  union  of 
the  oxygen  with  the  elements  of  the  metamor 
phosed  tissues,  has  recovered  its  original  tempera 
ture,  the  resistance  of  its  living  parts  to  the  oxygen 
conveyed  to  them  again  increases,  and  as  the  resist 
ance  of  other  parts  is  now  diminished,  a  more  rapid 
change  of  matter  now  occurs  in  them,  their  tempera 
ture  rises,  and  along  with  this,  if  the  cause  of  the 
change  of  matter  continues  to  operate,  a  larger 


ON    PATHOLOGY.  15 

amount  of  vital  force  becomes  available  for  mechani 
cal  purposes.  If  the  heat  is  abstracted  from  the 
whole  surface  of  the  body,  the  whole  action  of  the 
oxygen  will  be  directed  to  the  skin,  and  in  a  short 
time  the  change  of  matter  must  increase  throughout 
the  body." — (Liebig.) 

From  these  facts  we  are  led  to  conclude,  that  a 
large  amount  of  those  articles  which  abound  in  carbon 
and  hydrogen  should  be  consumed  in  cold  climates,  in 
order  that  sufficient  materials  may  be  constantly  fur 
nished  to  the  tissues,  to  afford  the  requisite  amount  of 
resistance  to  the  inspired  oxygen.  This  is  the  only 
means  by  which  the  animal  temperature  can  be  kept 
up  sufficiently  to  counteract  the  loss  of  heat  which  is 
constantly  occasioned  by  external  cold.  Disease 
must  always  occur,  when  cold  so  intense  and  protract 
ed  as  to  impair  the  normal  resisting  force  of  the  tis 
sues,  is  applied  to  the  body,  in  such  a  manner  as  to 
induce  atony  in  the  capillary  vessels,  chills,  lassitude, 
pain,  and  other  symptoms  of  inflammation.  One  of 
the  most  prolific  causes  of  disease,  in  cold  climates, 
is  generally  active  from  without,  in  the  form  of  sud 
den  changes  of  temperature,  excessive  exposure  to 
cold  when  the  body  is  enfeebled,  and  in  going  from 
heated  rooms  into  the  cold  while  perspiring.  In  these 
instances  the  effects  produced  are,  debility  and  con 
striction  of  the  extreme  vessels,  (chills,)  lassitude,  and 
pains  in  the  limbs  and  head,  followed,  as  soon  as  re 
action  comes  on,  by  accelerated  respiration,  circula 
tion,  and  other  symptoms  which  constitute  fever.  In 
regard  to  the  part  or  organ  affected,  much  will  depend 
upon  the  predispositions  and  constitution  of  the  patient. 
As  a  general  rule,  however,  the  greatest  impression 
is  usually  made,  and  the  force  of  the  disease  expended, 
upon  the  most  enfeebled  part.  If  the  lungs  are  pre 
disposed  to  disease,  the  exciting  cause  will  develop 
pneumonia.  If  the  brain  or  digestive  organs  have 
been  debilitated  by  excessive  exercise,  phrenitis  or 
gastritis  will  ensue.  The  same  principle  holds  true  with 
regard  to  the  other  organs  and  structures  of  the 
economy.  If  the  whole  system  be  in  a  normal  and 
sound  state,  atmospheric  vicissitudes  will  common 
ly  merely  predispose  the  organs  to  a  disordered 


10  (JENEKAL    OBSERVATIONS 

action  from  whatever  farther  exciting  cause  may  occur. 
But  repeated  exposure  to  sudden  changes  of  tempera 
ture,  even  in  a  sound  state  of  the  organs,  may  produce 
actual  disease. 

The  immediate  effect  of  the  above  enumerated,  as 
well  as  of  almost  all  other  causes  of  disease,  is  to 
impair  the  integrity  of  the  capillaries  to  such 
an  extent  as  to  render  them  incapable  of  excluding 
the  red  globules.  The  intromission  of  these  "car 
riers  of  oxygen,"  must  of  necessity  give  rise  to 
an  increased  and  unnatural  change  of  matter,  with  its 
concomitants,  augmented  heat  and  motion.  This  in 
flammation  of  parts  produces  obstruction  to  the  pas 
sage  of  the  excretions,  causing  them  to  be  retained 
within  the  system  to  serve  as  an  additional  source  of 
disturbance.  The  nature  and  activity  of  the  exciting 
cause,  the  part  affected,  and  the  constitution  of  the 
patient,  will  determine  the  violence  and  danger  of  the 
disease.  , 

It  may  then  be  assumed  with  safety,  that  the  chief 
influences  which  predispose  to  disease  in  all  countries, 
are  extremes  of  heat  and  cold,  and  abrupt  changes  of 
temperature. 

In  cold  latitudes,  those  affections  prevail  which  are 
induced  by  undue  exposure  to  cold,  and  from  the  con 
densed  state  of  the  air  respired.  Hence  pneumonic 
and  other  diseases  of  a  purely  inflammatory  charac 
ter. 

In  hot  regions,  where  the  respired  air  is  highly 
rarefied,  we  observe  those  disorders  which  proceed 
from  a  deficiency  of  oxygen  to  neutralize  the  ele 
ments  of  the  food,  and  from  exposure  to  the  burning 
rays  of  a  torrid  sun.  Liver  complaints,  yellow  and 
congestive  fevers,  and  those  diseases  which  an  excess 
of  carbon,  circulating  in  the  blood,  would  produce,  are 
here  found  in  abundance. 

The  diseases  of  moderate  latitudes  are  of  a  more 
mixed  character,  milder;  and  more  subservient  to  the 
power  of  remedies.  Here  frequent  and  sudden  at 
mospheric  changes  exert  the  greatest  influence  in 
disturbing  the  healthy  equilibrium,  and  in  inducing 
disease. 

Every  living  body  possesses  a  certain  definite  and 


ON    PATHOLOGY.  17 

limited  capacity  of  resistance.  This  capacity  can 
only  be  taxed  to  a  fixed  point,  without  deranging 
some  of  the  functions  and  causing  disease.  We  have 
seen  that  the  first  and  most  essential  requisite  to  en 
sure  health,  is  a  due  proportion  between  the  elements 
of  the  food  and  the  inspired  oxygen.  Now,  if  mode 
ration  and  regularity  be  exercised  in  all  the  duties  and 
habits  of  life,  a  sound  state  of  the  organs  and  a  due 
performance  of  all  the  functions  will  follow. 

Among  the  parts  of  which  the  normal  action  is  highly 
essential  to  the  well-being  of  the  individual,  and  upon 
which  disturbing  causes  usually  act,  are  the  digestive 
and  respiratory  organs,  the  skin,  and  nervous  system. 
Of  these,  the  lungs  and  skin  are  by  far  the  most  fre 
quently  affected.  Exposed  incessantly  to  noxious 
exhalations,  impure  air,  extremes  of  heat  and  cold, 
and  sudden  changes  of  temperature,  it  is  not  a 
matter  of  surprise  that  most  exciting  causes  operate 
primarily  upon  one  or  both  of  these  important  parts. 

Almost  all  inflammations  of  important  organs  are 
ushered  in  with  feelings  of  general  lassitude,  pains  in 
different  parts  of  the  body,  irregular  respirations,  and 
chills.  It  matters  not  whether  the  first  impression  has 
been  made  by  atmospheric  changes — extremes  of  heat 
or  cold — or  undue  mental  or  corporeal  exertion :  one 
important  phenomenon  is  witnessed  in  nearly  all  in 
stances,  that  is.  a  spasmodic  or  constricted  state  of  the 
extreme  vessels.  This  constriction  of  the  capillaries 
is  always  attended  with  more  or  less  debility,  which 
prevents  them,  when  re-action  comes  on,  from  resist 
ing  the  intromission  of  red  blood.  Thus  result  ob 
struction  to  the  excretions,  accelerated  change  of 
matter  in  these  parts,  and  the  other  phenomena  of 
inflammation  and  fever.  Now,  whatever  organ  or 
structure  is  most  predisposed  to  diseased  action,  must 
receive  the  greatest  detriment  from  the  retained  se 
cretions,  and  the  exalted  and  unnatural  action  which 
pervades  the  system. 

According  to  many  authors,  the  causes  of  inflamma 
tion  may  be  either  predisposing  or  exciting.  If  two  in 
dividuals,  one  robust,  and  regular  in  his  habits,  and  the 
other  delicate,  and  irregular,  be  exposed  to  the  same 
morbific  influence,  the  former  will  escape,  while  the  lat- 


18  GENERAL    OBSERVATIONS 

ter  will  receive  injury  ;  or,  if  the  exciting  cause  be  still 
more  active,  an  impression  will  be  made  upon  the 
first,  which  will  predispose  his  system  to  disor 
dered  action,  while  in  the  latter,  the  same  influence 
will  cause  actual  disease.  If  the  morbific  agent  be 
very  virulent,  actual  disease  may  be  induced  in  both 
instances,  but  in  different  degrees  of  severity. 

If  this  is  true,  it  may  be  asked  why  it  is  that  in  hot 
climates  the  robust  are  more  liable  to  be  attacked 
with  fevers,  than  those  of  a  feeble  appearance  ?  The 
reason  is  obvious.  The  system  of  the  vigorous  man 
abounds  with  those  elements  which,  when  properly 
decomposed  by  oxygen,  generate  the  vital  activity, 
and  produce  strength  and  health.  Now,  if  he  in 
dulges  his  appetite  as  usual,  while  he  inhales  a  highly 
rarefied  atmosphere,  disease  must  of  necessity  result ; 
for  unless  the  amount  of  oxygen  absorbed  into  the 
system  be  proportionate  to  the  elements  of  the  food 
assimilated,  much  of  the  latter  must  remain  unacted 
upon,  and  thus  serve  to  contaminate  the  blood,  and 
derange  the  functions  of  the  organs.  Here,  a  cause 
of  disease  exists,  to  which  the  feeble  man  is  but  little 
exposed.  His  system  is  characterized  by  a  deficiency 
rather  than  an  excess  of  carbon  ;  his  digestive  or 
gans  being  so  weak  that  no  more  of  the  elements  of 
nutrition  are  assimilated  than  the  inspired  oxygen  can 
neutralize.  Thus,  in  his  case,  the  equilibrium  between 
the  supply  and  waste  of  matter  is  retained,  and  the 
organs  remain  healthy. 

In  the  first  example,  a  strict  abstinence  from  ani 
mal  food,  liquors,  and  other  articles  abounding  in  car 
bon,  with  care  that  the  healthy  function  of  the  skin  be 
not  disturbed,  will  secure  as  great  freedom  from  dis 
ease  as  in  the  other  instance.  It  is  not  that  the  robust 
man  is  necessarily  more  prone  to  disease  than  the  other, 
but  because,  either  from  ignorance  or  imprudence,  he 
often  exposes  himself  uselessly  to  an  exciting  cause  to 
which  the  latter  is  not  liable. 

We  contend  that  the  man  of  stout  frame  and  vigor 
ous  constitution  is  better  able  to  resist  diseases  in  all 
climates  than  one  of  a  more  feeble  organization,  pro 
vided,  that  he  adapts  himself  by  his  habits  and  dietetic 
regulations,  to  the  climate  in  which  he  resides.  The 


ON    PATHOLOGY.  19 

grand  essential  consists  in  keeping  up  a  due  propor 
tion  between  the  elements  of  the  food  and  the  inspired 
oxygen.  So  long  as  this  proportion  is  preserved,  a  vast 
amount  of  exposure  can  be  sustained  in  any  climate, 
without  detriment. 

In  northern  latitudes,  those  who  are  feebly  organ 
ized,  or  of  nervous  or  sanguine  temperaments,  suffer 
far  more  than  the  robust  and  bilious.  In  such  cases 
it  is  necessary  that  the  amount  of  carbon  and  hydro 
gen  assimilated  to  repair  the  waste  of  the  tissues,  be 
very  large,  in  order  to  supply  the  system  with  sufficient 
material  to  resist  the  action  of  the  absorbed  oxygen. 
Let  it  be  remembered,  that  disease  ensues  whenever 
any  part  of  the  body  becomes  incapable  of  afford 
ing  a  definite  amount  of  resistance  to  the  action  of 
this  gas.  The  principal  source  of  this  resistance  is  the 
carbon  and  hydrogen  of  the  changed  tissues ;  and  if 
no  unusual  or  deleterious  causes  operate  to  depress 
the  system,  all  will  be  well.  If,  however,  the  digestive 
organs  become  disordered,  and  assimilation  checked — 
the  body  being  at  the  same  time  exposed  to  excessive 
cold — the  oxygen  will  act  upon  the  debilitated  struc 
tures  themselves,  in  order  to  find  sufficient  fuel  for 
combustion,  so  that  the  animal  temperature  may  be 
retained. 

The  phenomena  of  life  depend  upon  the  constant 
operation  of  two  antagonistic  elements.  Their  pre 
sence  and  activity,  in  suitable  proportions,  impart 
heat,  strength,  and  life,  while  the  absence  of  one 
makes  the  other  an  active  agent  in  causing  dis 
organization  and  death.  According  to  Lavoisier, 
a  quantity  of  oxygen  is  constantly  being  inspired 
by  the  healthy  adult,  equal  to  32±  oz.,  or  40,037 
cubic  inches,  daily,  the  tendency  of  which  is  to 
neutralize  and  destroy  the  elements  of  the  body.  To 
counteract  this  destructive  agent,  the  elements  of  the 
food  are  constantly  being  assimilated,  and  are  finally 
brought  into  contact  with  it.  In  this  manner,  so  long 
as  the  proportion  between  these  agents  is  equal,  those 
chemical  changes  take  place  which  generate  the  ani 
mal  heat,  corporeal  vigour,  and  motive  power,  serving 
to  keep  in  operation  the  whole  machine  and  ensure  the 
normal  action  of  every  organ.  The  immense  import- 


20  GENERAL    OBSERVATIONS 

ance,  then,  of  fully  comprehending  and  appreciating  the 
mutual  influence,  and  dependence  upon  each  other,  of 
the  respiratory  and  digestive  organs,  will  be  under 
stood  by  all. 

Extreme  cold  produces  disease  by  permitting  more 
oxygen  to  be  absorbed  by  the  blood  than  can  be  de 
composed  by  the  products  of  the  metamorphosed  tis 
sues.  Those  parts  of  the  body  possessing  the  least 
vitality  must  then  be  acted  upon,  and  inflammation, 
and  perhaps  disorganization,  ensue. 

Extreme  heat  generates  disease  from  causes  direct 
ly  the  opposite,  viz.,  a  deficiency  of  oxygen,  to  neu 
tralize  the  assimilated  carbon  and  hydrogen.  In  both 
instances  the  nervous  and  muscular  force  of  the  capil 
laries  is  so  impaired  as  to  render  them  incapable  of 
excluding  from  their  structure  the  red  globules.  Ob 
struction  is  thus  caused,  a  large  amount  of  heat  is 
evolved,  and  the  redness,  swelling,  and  pain,  which 
characterize  inflammation,  is  present. 

The  primary  cause  of  most  inflammations  is  a  dis 
proportion  between  the  action  of  the  oxygen  of  the 
blood  and  the  elements  of  the  changed  tissues. 
The  cause  of  this  disproportion — acting  upon  those 
parts  of  the  body  most  susceptible  to  its  influence — 
gives  rise  immediately  to  an  impaired  state  of  the 
nerves  and  muscular  fibres  of  the  extreme  vessels, 
rendering  them  incapable  of  preventing  the  intromis 
sion  of  the  red  blood.  The  first  effect  upon  these  ves 
sels  is  stimulant ;  indicated  by  contraction,  or  spasm,  and 
chills.  This  is  soon  followed  by  the  secondary  or  atonic 
stage,  which  is  indicated  by  distention  or  congestion 
of  th.e  capillaries  with  red  blood,  heat,  redness,  and 
other  symptoms,  which  show  that  the  small  vessels 
have  lost  their  power  of  resisting  the  entrance  of  the 
destructive  "  carriers  of  oxygen. "«  The  immediate 
cause  of  the  disturbance  and  disorganization  which 
results  in  inflamed  parts,  is  dependent  solely  upon  the 
chemical  action  of  the  oxygen  of  the  red  globules,  upon 
the  elements  of  the  affected  structure.  If  this  is  the 
case,  it  will  be  asked  why,  then,  disturbance  and  in 
flammation  do  not  take  place  from  the  red  globules  in 
the  act  of  blushing,  or  from  friction  ?  Because,  in  these 
instances,  the  nervous  and  muscular  force  of  the  capil- 


ON    PATHOLOGY.  21 

laries  remains  unimpaired,  and  they  are  thus  enabled 
speedily  to  throw  off  this  temporary  accession  of  red 
blood,  and  resume  their  normal  resistance  to  its  further 
entrance.  It  is  only  by  impairing  the  resisting  force  of 
these  vessels,  in  such  a  manner  that  the  arterial  blood 
continues  to  enter  them,  that 'inflammation  can  occur. 

Even  in  the  act  of  blushing,  a  perceptible  increase 
of  heat  is  apparent,  and  when  the  emotion  acts  intense 
ly,  and  for  a  considerable  period,  phenomena  similar 
to  those  which  occur  in  very  slight  superficial  inflam 
mations,  are  observed ;  as  uneasy  sensations,  fulness, 
perspiration,  &c. 

The  virulence  of  the  morbific  influence  acting  upon 
the  extreme  vessels,  and  the  extent  to  which  their  re 
sisting  power  is  impaired,  will  determine  the  vio 
lence  and  danger  of  the  inflammation. 

It  has  been  ascertained  by  Wilson  Philip  and  others, 
"  that  where  the  inflammation  of  a  part  is  greatest,  the 
vessels  are  more  distended,  and  the  motion  of  the 
blood  is  slowest."  This  is  owing,  undoubtedly,  to  the 
diminished  contractile  power  of  the  capillaries ;  and  it 
is  probable,  in  inflammations  of  a  congestive  charac 
ter,  that  this  contractile  or  resisting  power  is  almost 
entirely  destroyed.  This  fact  is  important,  in  a  thera 
peutical  point  of  view,  inasmuch  as  it  directs  us  to 
apply  our  remedies  in  such  a  manner  as  to  restore  the 
loss  of  tone  of  the  extreme  vessels,  as  the  most  direct 
method  of  cure.  We  shall  hereafter  take  occasion  to 
advert  to  this  subject  again,  when  we  shall  dilate  upon 
it  more  fully. 


22 


CHAPTER  III. 

DOCTRINES   RESPECTING  A  VITAL    PRINCIPLE,  NERVOUS 
FLUID,  DYNAMIC  INFLUENCE,  <fcc. 

All  authors  upon  physiology  and  medicine,  have 
written  much  about  a  "  vital  principle"  a  "nervous 
force"  &c.  They  speak  of  them  as  immaterial  an(} 
mysterious  agents,  which  perform  all  of  the  most  won 
derful  offices  in  the  human  economy.  They  are  sup 
posed  to  be  distinct  from  the  intelligence,  or  soul,  and 
to  possess  a  kind  of  subtle  and  mysterious  power, 
which  accomplishes  all  those  difficult  operations,  in 
the  phenomena  of  life,  which  physiologists  are  unable 
to  understand  or  explain. 

"  There  is  not,"  says  Paine,  "  in  the  whole  range  of 
medical  literature,  one  author,  however  devoted  to 
the  physical  and  chemical  views  of  life,  who  does 
not  evince  the  necessity  of  admitting  a  governing 
vital  principle,  as  a  distinct  entity,  distinct  from  all 
other  things  in  nature.  I  say,  there  cannot  be  pro 
duced  one  author  of  any  consideration,  who  does  not 
summon  to  the  aid  of  his  discussion  a  vital  principle, 
whenever  he  touches  upon  the  abstract  phenomena 
of  life." 

But  what  proof  have  we  that  such  a  principle 
actuates  the  body?  What  good  reason  is  there  for 
assuming  the  existence  of  a  peculiar,  immaterial 
power,  independent  of  the  soul  ?  "  To  speak  of  the 
vital  forces,  to  give  them  a  definition,  to  interpret 
phenomena  by  their  aid,  and  yet  to  be  ignorant  of  the 
laws  which  govern  them,  is  doing  nothing,  or  rather 
is  doing  what  is  worse  than  nothing.  It  is  to  attempt 
an  impossibility,  it  is  to  content  the  mind  to  no  pur 
pose,  to  stop  the  search  after  truth.  To  state  that  the 
liver  separates  the  elements  of  the  bile  from  the  blood 
by  means  of  the  vital  force,  is  merely  to  assert  that 
the  bile  is  formed  in  the  liver.  By  thus  varying  the 
expression,  a  dangerous  illusion  is  established." — 
(Matteucci  on  Living  Beings,  p.  29.) 

We  know  that  every  part  of  the   organism  has  its 


.     DOCTRINES    RESPECTING    A    "  VITAL    PRINCIPLE,"    ETC.        23 

own  special  function,  the  physical  operation  of  which 
we  can  fully  comprehend  ;  but  superadded  to  all  of 
these  parts,  there  is,  undoubtedly,  a  subtle  and  mys 
terious  agency,  the  soul.  Shall  we  now  add  to  the 
system  a  power  which  was  never  disclosed  by  the 
Creator — an  assumed,  vague,  and  indefinite  principle, 
concerning  which  we  are  entirely  ignorant,  and  which 
can  serve  no  purpose  but  to  cover  up  ignorance,  and 
securely  conceal  absurd  hypotheses  ?  Shall  we  pre 
tend  that  when  God  created  man  from  clay,  and 
'*  breathed  into  his  nostrils  the  breath  of  life,  and  he 
became  a  living  soul"  he  also  infused  another  prin 
ciple,  similar  to  but  distinct  and  independent  of  the 
soul  ? 

We  are  of  opinion  that  much  error  has  arisen 
from  the  general  idea,  that  the  intelligence  is  es 
tablished  exclusively  in  the  brain,  and  that  it  possesses 
only  certain  limited  powers.  That  its  highest  and 
most  important  manifestations  proceed  from  this  organ, 
there  is  no  doubt,  because  the  special  senses  are  loca 
ted  here.  Sight,  hearing,  smell,  &c.,  are  all  recog 
nised  and  appreciated  here,  because  the  organs  through 
which  we  are  sensible  of  these  phenomena,  are  in  this 
vicinity ;  but  in  other  parts  it  exercises  its  influence 
directly  and  often  independently  of  the  brain  and  spi 
nal  cord. 

In  regard  to  the  nature  of  the  intelligence,  or  soul, 
and  how  it  acts  upon  the  material  parts,  to  aid  in  pro 
ducing  the  phenomena  of  life,  can  never  be  known. 
We  are  able  to  see  its  results  and  appreciate  its  won 
derful  influences,  but  the  mode  of  its  operation  is  abso 
lutely  inexplicable.  It  pervades  every  part  of  the 
body,  acting  as  a  stimulus  to  each  organ,  giving  rise 
to  sensation  in  the  organs  of  sense,  motion  in  the  or 
gans  of  motion,  digestion,  absorption,  assimilation, 
respiration,  circulation,  &c.,  in  the  organs  provided  for 
these  functions. 

All  modifications  or  derangements  of  structure, 
alter  the  peculiar  effects  of  this  spiritual  stimulus ; 
for  it  acts  only  through  the  medium  of  the  organs  as 
they  actually  exist.  All  deviations  therefore  from 
the  normal  organization  of  parts,  induces  corres- 


24       DOCTRINES    RESPECTING    A    "  VITAL    PRINCIPLE,"  ETC.        . 

ponding  alterations  in  the  manifestations  of  the  intel 
ligence. 

The  soul  has  no  particular  location,  but  pervades 
every  portion  of  the  nervous  system,  exercising  a  con 
stant  and  direct  influence  over  every  organ  and  tissue. 
This  is  clearly  apparent  from  the  experiments  of 
Philip,  Stilling,  Hall,  and  others,  which  prove  "that 
the  power  of  the  heart  and  vessels  of  circulation  is 
independent  of  the  brain  and  spinal  marrow,"  and 
"  that  the  power  of  the  muscles  of  voluntary  motion, 
vessels  of  secretion,  and  peristaltic  motion  of  the 
stomach  and  intestines,  are  independent  of  the  ner 
vous  system,  and  that  their  relation  to  this  system  is 
of  the  same  nature  with  that  of  the  heart  and  vessels 
of  circulation — the  nervous  power  influencing  them  in 
no  other  way  than  as  other  stimuli'  and  sedatives  do." 
From  these  and  other  experiments,  Dr.  Philip  supposes 
that  the  vessels  possess  "  a  principle  of  motion  inde 
pendent  of  their  elasticity,"  and  identical  with  gal 
vanism. 

The  experiments  of  Majendie  have  shown,  "  that 
the  hemispheres  of  the  brain  and  cerebellum  may  be 
removed  in  a  mammiferous  animal,  and  it  will  continue 
to  experience  sensation,  odours,  sounds,  and  sapid  im 
pressions.  Vision,  however,  is  abolished." 

Dr.  Dowler,  of  New  Orleans,  has  very  recently  in 
stituted  a  series  of  experiments  on  the  alligator, 
which  demonstrate  in  the  clearest  manner  the  position 
which  we  have  advanced,  respecting  the  peculiar  ope 
ration  of  the  soul,  or  intelligence,  upon  the  organism. 
In  one  experiment,  Dr.  D.  divided  the  muscles  of  the 
neck,  the  cervical  vertebrae,  and  the,  spinal  cord,  also 
the  spinal  cord  between  the  shoulders  and  hips,  de 
stroyed  the  sympathetic  nerve,  and  removed  the  intes 
tinal  viscera,  "  yet,  for  a  period  of  more  than  two 
hours,  the  alligator  exhibited  complete  intelligence, 
volition,  and  voluntary  motion  in  each  and  all  divisions 
of  the  body.  It  saw,  felt,  and  defended  itself ;  showed 
anger,  fear,  and  even  friendly  attentions  to  its  keeper, 
a  black  boy"  In  another  experiment,  " the  upper  por 
tion  of  the  skull,  including  a  horizontal  stratum  of 
brain,  was  removed.  The  animal  performed  a  series 
of  voluntary  motions,  intelligibly  directed,  to  ward  off 


DOCTRINES    RESPECTING    A   VITAL    PRINCIPLE,  ETC.         25 

injuries.     The  entire  brain  and  the  medulla  oblongata 
were  now  removed*,   without   diminishing   its  power  to 
direct  its  limbs  to   any  part   that  was  pained   by  the 
slightest  touch  of  a  pin  or  knife.     A  metallic   rod  was 
passed  many  times  within  the  spinal  cor"d,  completely 
destroying  the  spinal  marrow  beyond  the  hips.    It  was 
still  found  that  both  voluntary  motion   and  sensation, 
remained,  though   their  manifestations  were  greatly 
impaired."     Dr.  D.  concludes  from   these  and  nume 
rous  other  experiments  of  a  similar  nature,  "  that  vo 
luntary  motion  is  neither  directly  communicated  from 
nor  regulated  by  the  brain,  or  the  cerebellum  ;  that 
the  muscles,  in  connection  with  the  spinal  marrow, 
perform    voluntary   motions  for    hours    after   having 
been  severed  from  the  brain  ;  that  these  motions  are 
not  only  entirely  independent  of  the  brain,  but  may 
take  place,  though  imperfectly,  after  the  destruction 
of  the  cord  itself;  that  the  trunk,  as  well  as  the  brain, 
thinks,  feels  and  wills,  or  displays  psychological  pheno 
mena  ;  that  the  sensorium  is  not  restricted  to  a  single 
point,  but  is  diffused,  though  unequally,  or  in  a  dimin 
ished  degree,  in  the  periphery  of  the  body  ;  and  that  ac 
tions  which  take  place   after  decapitation,  as  described 
above,  are  in  absolute  contrast  to  REFLEX  ACTIONS,  being 
sensational,  consentaneous,  voluntary,  and  in  other  re 
spects  dissimilar."     Is  it  any  more  wonderful  that  the 
soul  conduces  to  the  phenomena  of  digestion,  assimi 
lation  and  appropriation,  when  the  natural  stimuli  of 
these  organs  are  presented  to  them,  than  that  sight 
is  appreciated  when  the  natural  stimuli  of  the  eye, 
the  rays  of  light,  are  applied  to  this  organ?     Is  it  any 
more  singular  that  this  spiritual  stimulus  should  endow 
^ach  structure  with   power   to   exclude   all   noxious 
substances,  and  select  each  its  natural  excitant,  than 
that  the  sense  of  hearing  should  only  appreciate  one 
voice,  in  the  midst  of  a  hundred  other  voices  and  in 
struments,  whenever  the  will  so  directs  ? 

In  order  to  acquire  a  correct  idea  of  the  functions 
of  life,  it  is  necessary,  in  the  first  instance,  to  contem 
plate  the  body  as  a  perfect  machine — adapted  in  every 
part  by  a  definite  and  special  organization,  to  receive 
different  impressions  according  to  the  nature  of  the 
substances  or  excitants  presented,  and  the  offices 
2 


26       DOCTRINES    RESPECTING    A    VITAL    PRINCIPLE,    ETC. 

which  they  are  destined  to  perform.  Without  doubt 
chemical  and  mechanical  forces  exercise  an  important 
influence  in  the  operations  of  this  machine.  The  com 
bustion  of  oxygen  with  the  carbon  at  the  lungs,  and 
in  other  parts  of  the  system,  must  develop  heat,  ex 
pansion  and  motive  power,  and  mechanical  causes 
may  operate  somewhat  in  adding  to  this  force,  yet  all 
of  these  influences  are  wholly  inadequate  to  accom 
plish  and  perpetuate  the  more  complicated  phenomena 
of  life.  It  is  then  essential  that  another  important 
agency  should  be  every  where  present,  in  order  to 
enable  the  organs  to  respond  properly  to  their  special 
stimuli.  Consequently  we  have  "  superadded  to  the 
body"  an  intelligence  which  affords  a  specific  stimulus 
to  every  part ;  acting  solely  through  each  particular 
structure  as  it  exists,  and  modified  in  its  operation 
according  to  the  modifications  or  alterations  in  the 
organs  themselves.  If  the  structure  of  the  eye  is 
injured,  an  imperfect  image  will  be  formed  upon  the 
retina,  the  intelligence  will  manifest  itself  through 
this  injured  structure,  and  this  sense  altogether  im 
paired.  If  the  structure  of  other  organs  be  altered,  so 
that  their  natural  stimuli  cannot  be  brought  to  bear  as 
usual,  the  operation  of  the  spiritual  stimulus  will  be 
modified  in  proportion,  and  disordered  function  result. 
This  stimulus  acts  at  each  particular  part,  specifi 
cally,  and  in  a  measure  independently  of  other  parts, 
causing  irritability  of  different  grades  in  the  muscular 
fibres,  and  exercising  those  peculiar  properties  every 
where,  which  have  been  erroneously  attributed  to  a 
different  and  independent  principle,  the  vital  force. 
The  influence  likewise  which  it  exercises  upon  the 
body  as  a  cause  of  disease  has  never  jet  been  properly 
appreciated.  This  is  due,  first,  to  the  erroneous  sup 
position  that  the  operations  of  the  soul  are  confined 
to  simple  conception,  judgment,  comparison,  and  other 
intellectual  phenomena ;  and,  secondly,  to  the  before- 
mentioned  arbitrary  custom,  derived  from  antiquity, 
of  attributing  all  other  phenomena  connected  with 
the  organism,  which  cannot  be  explained  by  the  known 
laws  of  matter,  to  the  agency  of  another  influence,  to 
which  Hippocrates  gave  the  name  of  phusis,  Paracel 
sus  and  Van  Helmonf  of  archcus.  and  Stahl  of  anima, 


DOCTRINES    RESPECTING    A    VITAL    PRINCIPLE,    ETC.         27 

but  which  medical  men  of  the  present  day  designate 
as  the  "  vital  principle  "  "  vital  properties"  "  vis  vitce" 
"  vis  insita"  &c. 

But  what  reason  is  there  for  limiting  the  influence 
of  the  soul  to  the  mere  intellectual  operations  ?  What 
good  reason  for  supposing  that  the  soul  is  located 
exclusively  in  the  brain,  and  that  the  rest  of  the  body 
is  only  acted  upon  indirectly  and  secondarily  by  this 
subtle  and  immaterial  power  ? 

In  the  ordinary  waking  state,  the  operations  of  the 
soul  are  manifested  directly  through  the  media  of 
all  the  physical  structures,  and  these  manifestations 
are  limited  in  extent  and  variety,  and  subject  to  cer 
tain  fixed  laws,  having  reference  to  the  structures  and 
the  stimuli  acting  upon  them.  Thus,  the  power  and 
extent  of  vision  is  determined  by  the  physical  condi 
tion  of  the  eyes,  and  the  brain  (wrhich  furnishes  them 
with  bloodvessels  and  nerves),  and  the  number  and  in 
tensity  of  the  rays  of  light  which  strike  the  retina. 
Light,  in  this  instance,  is  the  material  stimulus,  which 
passes  through  the  structure  of  the  eye  in  the  same 
manner  as  it  passes  through  an  optical  instrument, 
producing  the  reflection  of  images  upon  the  retina  in 
a  manner  analogous  to  images  formed  in  a  camera  ob- 
scura.  The  soul  takes  immediate  cognizance  of  these 
images  upon  the  retina,  in  precisely  the  same  manner 
that  it  recognises  the  images  in  the  camera  obscura.  It 
is  worthy  of  note,  that  these  images  may  be  formed 
upon  the  retina,  and  yet  the  soul  be  entirely  uncon 
scious  of  them  :  so  may  an  absent-minded  man  look 
into  a  camera  obscura,  filled  with  reflected  figures,  and 
derive  no  impressions  from  them.  Without  this  in 
visible,  incomprehensible,  and  eternal  soul,  the  eye 
would  be  but  a  mere  optical  instrument,  perhaps 
taking  the  first  rank  amongst  such  instruments,  but 
entirely  on  a  par  with  them,  and  subject  to  similar 
laws.  No  material  agent,  like  electricity,  magnetism, 
galvanism,  or  what  has  been  termed  animal  fluid, 
could  ever  enable  it  to  appreciate  impressions,  or  per 
form  a  single  act  of  intelligence. 

Every  structure  of  the  organism,  whether  situated 
within  the  cranium,  chest,  abdomen,  or  in  any  other 
part,  is  in  a  similar  condition  in  relation  to  the  soul, 


28         DOCTRINES    RESPECTING    A    VITAL    PRINCIPLE,    ETC. 

and,  without  its  presence  and  influence,  is  subject 
only  to  the  ordinary  laws  of  matter.  Let  those  che 
mical  theorists  who  suppose  that  the  organism  is  ac 
tuated  by  electricity,  galvanism,  magnetism  or  caloric, 
instead  of  by  an  immaterial  and  incomprehensible 
spirit,  adduce  a  single  example  in  which  the  former 
agents  have  acted  on  matter  in  such  a  manner  as  to 
produce  an  idea,  or  anything  analogous  to  reason,  and 
we  will  then  allow  that  such  doctrines  are  worthy  of 
consideration. 

It  is  the  office  of  the  soul  to  preside  over  the  neces 
sities  of  the  physical  man — to  guard  against  and  ward 
off  injurious  influences,  and  to  respond  to  all  impres 
sions  made  upon  the  textures.  So  long  as  the  normal 
physical  condition  exists,  and  no  undue  influence  is 
exerted  upon  the  mind,  a  spiritual,  or,  (as  others  will 
have  it,)  a  vital  equilibrium,  is  maintained  throughout 
the  system  ;  but  if  a  part  be  attacked  by  an  enemy  in 
the  form  of  inflammation,  or  if  an  undue  impression 
is  made  upon  the  mind,  this  equilibrium  is  disturbed — 
the  spiritual  force  is  unequally  distributed,  and  disor 
dered  action  follows. 

We  append  a  few  examples  to  illustrate  the  in 
fluence  of  mental  impressions  in  modifying  the  action 
of  the  tissues :  An  individual  in  perfect  health,  and 
undisturbed  by  any  external  influence,  finds  himself 
in  a  gallery  of  paintings.  At  one  point  a  devoted 
daughter  is  seen  braving  the  horrors  of  a  foul  dun 
geon,  to  offer  from  her  own  breast  sustenance  to  an 
aged  and  starving  father,  and  while  we  look,  the  lach 
rymal  glands  are  excited,  and  unbidden  tears  flow 
freely.  At  another  point,  an  inhuman  monster  has 
seized  an  innocent  child,  and  is  in  the  act  of  dashing 
out  its  brains  against  the  wall,  and  while  we  gaze,  the 
blood  mounts  to  the  brain,  the  cheeks  glow  with  in 
dignation,  and  the  heart  throbs  violently  at  the  bare 
contemplation  of  the  outrage.  Another  tableau  meets 
the  view,  and  we  see  the  executioners  in  the  act  of 
casting  a  struggling  criminal  into  a  den  of  poisonous 
serpents,  and,  as  we  behold  the  reptiles  coiled  up  for 
a  deadly  spring,  with  fiery  eyes  and  forked  tongues, 
the  blood  forsakes  the  surface,  the  stomach  sickens, 
the  heart  sinks,  and  a  cold  shudder  steals  over  the 


DOCTRINES    RESPECTING    A    VITAL    PRINCIPLE,    ETC.         29  * 

whole  system.  Another  scene  presents  itself :  we  be 
hold  a  table  loaded  with  the  most  tempting  viands 
and  fruits,  and  an  immediate  change  occurs  in  the 
salivary  glands,  the  mouth  fills  with  saliva,  the  stom 
ach  indicates  its  want,  and  a  general  perturbation  of 
the  digestive  system  ensues.  The  mere  sight  of  an 
epileptic  often  induces  a  corresponding  complaint  in 
others;  the  indulgence  of  bad  habits  in  one  member 
of  a  family,  like  snuffling,  distortion  of  the  mouth, 
eyes,  &c.,  frequently  bring  about  the  same  habits  in 
other  members  of  the  family.  Violent  emotions  from 
sudden  intelligence,  whether  good  or  bad,  often  induce 
diarrhoeas,  syncope,  catalepsy,  apoplexy,  mania,  &c. ; 
tear  and  apprehension  are  most  powerful  predisposing 
causes  of  disease,  and  when  excessive,  often  act  as 
exciting  causes,  particularly  during  the  prevalence  of 
epidemic  and  contagious  affections,  as  cholera  as 
phyxia,  small-pox,  yellow  and  typhus  fevers,  &c.  Pro 
tracted  grief  is  a  common  cause  of  chronic  diseases, 
like  dyspepsia,  jaundice,  neuralgia,  hypochondria,  pkthi- 
sis  pulmonalis,  &c.  Intense  and  exclusive  application 
to  any  given  subject,  eventually  causes  disease  of  the 
brain  and  nervous  system,  and  mental  derangement. 
The  hypochondriac,  who  suffers  under  the  effects  of 
some  morbid  fancy,  continues  to  feed  his  malady  by 
pondering  over  his  imaginary  ailments ;  the  monoma 
niac,  as  he  dwells  upon  his  delusion,  fans  the  flame 
which  is  consuming  him.  If  an  individual  in  the  most 
perfect  health  be  told  by  several  different  persons  that 
he  looks  pale,  haggard,  and  sick,  it  is  more  than  pro 
bable  that  the  impression  will  exercise  so  powerful  an 
influence,  that  he  will  actually  feel  sick,  and  take  to 
his  bed :  we  have  witnessed  more  than  one  example 
of  this  kind.  In  disease,  also,  the  manner,  bearing 
and  expression  of  the  physician,  often  exert  the  most 
surprising  effects  upon  the  patient,  either  in  ameliora 
ting  or  aggravating  his  malady.  Most  diseases  are 
attended  with  an  exalted  state  of  the  nervous  system, 
and  with  a  highly  sensitive  and  irritable  condition  of 
the  mental  faculties.  In  this  condition,  a  doleful  ex 
pression  of  countenance,  or  words  of  doubt,  discou 
ragement  and  sadness,  are  often  capable  of  plunging 
the  patient  into  the  most  profound  state  of  mental 


y  DOCTRINES    RESPECTING    A    VITAL    PRINCIPLE,    ETC. 

and  physical  depression,  and  thus  aggravating,  to 
a  serious  extent,  his  malady ;  while  on  the  other 
hand,  a  cheerful  face,  a  lively  and  agreeable  manner, 
and  words  of  hope  and  encouragement,  usually  exer 
cise  an  influence  of  the  most  favourable  character, 
and  conduce  very  materially  in  bringing  about  a  cura 
tive  reaction  of  the  organism.  It  should  never  be  for 
gotten,  that  courage,  hope,  confidence,  and  a  cheerful 
state  of  mind,  are  powerful  tonics,  arid  often  enable 
the  healthy  system  to  resist  the  influence  of  conta 
gious,  epidemic,  and  other  noxious  impressions,  and 
the  sick  organism  to  combat  successfully  the  destruc 
tive  effects  of  disease  ;  while  fear,  apprehension,  grief, 
despair  of  recovery,  sadness,  and  depression  of  spirits, 
by  impairing  the  resisting  powers  of  the  economy, 
become  both  predisposing  and  exciting  causes  of  dis 
ease.  Show  me  a  physician  who  has  attained  a  high 
reputation  in  the  treatment  of  difficult  and  dangerous 
cases  of  disease,  and  I  will  have  confidence  that  he 
is  one  who  carries  a  cheerful  face  ;  who  delights  in 
dwelling  upon  the  bright  and  pleasant  things  of  life, 
rather  than  upon  those  which  are  gloomy  and  dismal ; 
and  who  does  not  fail  to  infuse  into  his  patients,  and 
all  around  him,  confidence,  hope,  and  comfort.  The 
expression  and  bearing  of  such  a  man  always  act  as  a 
beacon  of  hope,  to  arouse  the  sinking  energies  of  the 
patient,  and  to  encourage  him  to  strive  against  the 
depressing  influence  of  his  malady.  In  these,  and 
other  analogous  instances,  it  is  the  intelligence  alone 
which  is  operated  on,  and  which  diffuses  it$  influence, 
not  over  any  vital  properties  of  the  organism,  but 
upon  the  respiratory,  circulatory,  digestive,  and  ner 
vous  systems. 

We  have,  then,  constantly  operating  upon  the  ma 
chine,  first,  what  may  be  termed  the  material,  or  natu 
ral  stimuli,  and  second,  the  immaterial,  or  spiritual 
stimuli,  both  of  which  are  absolutely  essential  to  the 
continued  performance  of  the  functions.  In  some 
parts  of  the  organism,  these  material  excitants  must 
be  constantly  present,  in  order  that  the  system  may 
be  kept  in  operation.  The  heart  and  blood-vessels, 
and  the  respiratory  organs,  must  be  incessantly  acted 
upon  by  the  blood  and  atmospheric  air,  in  order  to 


DOCTRINES    RESPECTING    A    VITAL    PRINCIPLE,    ETC.        31 

ensure  life.  Other  parts,  like  the  stomach,  lacteals, 
capillaries,  &c.,  may  be  deprived  of  their  natural 
stimuli  for  a  length  of  time  without  causing  death, 
but  not  without  inducing  derangement  of  function, 
and  disease.  These  material  stimuli  not  only  exercise 
a  highly  important  influence  in  the  phenomena  of  life, 
but  it  is  upon  them  that  morbific  and  other  noxious 
impressions  are  often  made  in  causing  disease.  Ac 
cording  to  Liebig,  "  the  slightest  action  of  a  chemical 
agent  upon  the  blood,  exercises  an  injurious  influence." 
Any  material  deviation,  then,  from  the  natural  proper 
ties  of  the  inspired  air,  or  the  other  stimulants  of  the 
organism,  must  constitute  a  source  of  disease. 

The  other  agency  exerts  a  not  less  important  in 
fluence  over  all  parts  of  the  body,  and  gives  rise  to  its 
manifestations  in  accordance  with  the  peculiar  organ 
ization  and  modification  of  each  structure.  This 
property,  which  has  been  attributed  to  the  "  vital 
principle,"  or  "  nervous  force,"  is  due  solely  to  an  im 
material,  or  spiritual  agency — the  intelligence,  or  soul. 

The  operation  of  this  intelligence  upon  the  organs, 
produces  that  peculiar  state  which  enables  them,  when 
supplied  with  their  material  stimuli,  to  accomplish 
their  functions.  It  manifests  its  power  in  the  capilla 
ry  system  in  enabling  these  vessels  to  exclude  the  red 
globules ;  over  the  lacteals,  in  enabling  them  to  ex 
clude  all  but  the  nutritious  portions  of  food  ;  over  the 
organs  of  involuntary  motion,  in  enabling  them  to 
respond  with  uniformity  and  regularity  to  their  mate 
rial  excitants ;  over  the  nerves  of  sensation  and  mo 
tion,  in  enabling  them  to  take  cognizance  of  injurious 
foreign  impressions,  and  to  exercise  voluntary  mo 
tions  ;  over  the  organs  of  the  special  senses,  in  ena 
bling  them  to  appreciate  sight,  hearing,  smell,  taste, 
and  touch.  This  spiritual  influence  operates  only 
through  the  medium  of  these  organs  and  tissues,  de 
veloping  specific  and  harmonious  manifestations,  ac 
cording  to  the  peculiar  use  and  structure  of  each  part. 
Under  its  guidance  the  molecules  are  appropriated,  and 
become  a  part  of  the  organism.  Through  the  same 
influence  the  system  is  enabled  to  resist,  to  a  certain 
extent,  morbific  and  other  injurious  impressions.  It  is 
this  stimulus  which  endows  each  tissue  with  its  spe- 


32        DOCTRINES    RESPECTING    A    VITAL    PRINCIPLE,    ETC. 

cific  irritability,  causing  each  part  to  recognise  and 
respond  to  its  own  natural  material  excitant,  and  offer 
resistance  to  the  application  of  all  disturbing  agen 
cies. 

The  soul  does  not  leave  the  body,  until  the  struc 
tures  are  so  much  injured,  that  the  functions  all  cease 
operation.  Many  organs  may  be  destroyed,  or  ren 
dered  incapable  of  transmitting  mental  or  spiritual 
impressions,  yet  the  intelligence,  entire  and  unaltered 
of  itself,  will  still  pervade  the  remaining  portions  of 
the  organism.  It  will  still  manifest  itself  just  so  far 
as  it  finds  normal  organs  and  tissues  to  operate 
through  or  manifest  an  influence  upon.  The  material 
parts  alone  may  be  impaired  or  obliterated,  but  so 
long  as  there  is  life,  the  immaterial  part  must  pervade 
the  body,  unaltered,  although  its  manifestations  may 
be  entirely  changed. 

The  objections  which  we  have  advanced  in  rela 
tion  to  a  vital  principle,  apply  with  equal  force  to 
the  arbitrary  and  improper  use  of  what  is  termed 
dynamic  influence.  Hahnernann,  when  •  alluding,  in 
his  Materia  Medica,  to  the  therapeutic  power  of  the 
sixtieth  potency  of  thuja,  remarks  in  a  note  as  fol 
lows:  "  The  discovery  that  trituration  and  succussion 
develop  the  medicinal  properties  of  drugs,  in  propor 
tion  as  these  processes  are  carried  on  further,  until 
the  material  substance  shall  have  been  transformed, 
as  it  were,  into  medicinal  spirit,  is  of  inexpressible 
value,  and  so  undeniable,  that  those  who,  from  a 
want  of  knowledge  of  the  .resources  of  Nature,  con 
sider  homoeopathic  attenuations  as  mere  mechanical 
divisions  of  the  original  drug,  must  be  struck  dumb 
whenever  they  consult  experience." 

We  regret  that  the  great  Hahnemann  has  fallen 
into  the  fatal  and  universal  error  of  the  allopaths, 
since  the  days  of  Hippocrates,  of  calling  things  by 
their  wrung  names,  and  of  endeavouring  to  explain 
phenomena  which  cannot  be  explained  in  the  existing 
state  of  science. 

Experience  teaches,  that  minute  atoms  of  certain 
drugs  possess  more  power  to  impress  the  structures 
of  the  organism,  than  larger  quantities  of  the  same 
drug  in  a  crude  state. 


DOCTRINES   RESPECTING  A  VITAL  PRINCIPLE,  ETC.  33 

Hahnemann,  carrying  his  trituration  and  succussion 
to  a  great  extent,  and  still  finding  powerful  remedial 
effects,  hastily  and  quite  arbitrarily  concludes,  that 
"  the  material  substance  has  been  transformed  into  a 
medicinal  spirit."  This  inference,  in  our  humble 
opinion,  is  altogether  absurd  and  unwarrantable. 
Who  supposes  it  possible,  that  a  material  substance 
can  be  transformed  into  a  spiritual  one  ?  Who  sup 
poses  that  matter  can  be  reduced,  by  any  process, 
into  any  thing  but  matter,  in  a  different  state  of  at 
tenuation  ?  Medicinal  spirit,  and  dynamic  proper 
ties,  are  vague,  and  as  we  believe,  absurd  expres 
sions,  calculated  to  lend  an  air  of  mystery  to  ex 
plicable  phenomena,  and  lead  to  erroneous  views  re 
specting  homoeopathy.  We  unhesitatingly  assert, 
from  positive  observation  in  many  instances,  that  high 
attenuations  of  drugs  possess  the  power  to  impress 
the  human  organism,  under  certain  circumstances  ; 
but  what  reason  has  Hahnemann,  who  made  this  im 
portant  discovery,  to  assert  that  such  drugs  have  been 
transformed,  by  trituration  and  succussion,  into  a 
spirit,  or  an  immaterial  nothing  1  Because  the  present 
knowledge  of  chemistry  does  not  enable  us  to  analyze 
and  detect  minute,  atoms  of  matter,  has  any  man  a 
right,  for  this  reason,  to  declare  that  a  material  sub 
stance  can  be  reduced  into  a  spiritual  and  immaterial 
one  ?  Because  our  scales  are  not  sufficiently  delicate 
to  weigh  the  medicinal  atoms  existing  in  high  atten 
uations,  —  or  our  optical  instruments  sufficiently 
powerful  to  see  them,  shall  we  say  that  they  abso 
lutely  have  no  weight,  or  that  matter  has  been  anni 
hilated? 

Are  there  any  who  suppose,  that  the  miasmatic 
particles  which  arise  from  vegetable  decomposition 
and  produce  fevers,  or  the  contagious  effluvium  which 
arises  from  smallpox,  scarlet  fever,  or  measles,  or  the 
vapours  which  arise  from  ether,  chloroform,  hydro 
cyanic  acid,  &c.,  have  become  obliterated,  annihi 
lated,  and  extinct,  so  that  they  possess  no  form, 
weight  or  substantial  existence  whatever,  as  soon  as 
they  escape  into  the  air  in  imponderable  atoms,  though 
becoming  capable  of  impressing  the  structures  of  the 
body  so  violently  ?  Are  there  any  who  doubt,  that  in 

2* 


34          DOCTRINES  RESPECTING  A  VITAL  PRINCIPLE,  ETC. 

all  these  instances,  something  material  is  introduced 
into  the  blood,  and  conveyed  to  certain  textures  to 
produce  an  impression  by  contact  ?  Let  us  rather 
acknowledge  that  the  still  imperfect  state  of  science 
does  not  enable  us  to  analyze  and  detect  these  mi 
nutely  attenuated  atoms,  rather  than  resort  to  an 
absurdity,  to  cover  our  want  of  knowledge,  by  calling 
them  spiritual,  vital,  or  dynamic. 

The  great  stumbling-block  which  has  always  been 
in  the  way  of  real  advancement  in  medical  know 
ledge,  is  the  propensity  which  has  existed  to  explain 
things  which  were  difficult,  or  perhaps  not  at  all 
susceptible,  of  explanation,  by  vague  and  unmeaning 
terms,  instead  of  acknowledging  our  ignorance,  and 
awaiting  farther  developments  in  science.  Shall  we 
say  of  atmospheric  air,  azote,  oxygen,  hydrogen,  car 
bonic  acid,  and  other  gases,  that  they  are  spiritual 
and  immaterial,  and  exercise  their  effects  upon  the 
organism  dynamically,  simply  because  we  cannot 
weigh  or  behold  the  precise  form  and  size  of  the  mi 
nute  molecules  of  which  these  gases  are  composed  ? 
Is  it  supposed,  when  air  is  introduced  into  the  lungs, 
that  an  immaterial  substance  enters  into  chemical  com 
bination  with  the  carbon  of  the  blood,  changing  it 
from  a  dark  to  a  bright  red  colour,  and  giving  rise 
to  the  legitimate  effects  of  chemical  action  between 
two  material  substances,  viz.,  caloric  and  expansion  ? 
When  we  pour  a  heavier  into  a  lighter  gas,  as  for 
example,  carbonic  acid  gas  into  common  air,  is  it  sup 
posed  that  the  former  falls  to  the  bottom  and  usurps 
the  place  of  the  latter,  by  some  vital,  spiritual,  or  dy 
namic  influence,  or  simply  by  the  force  of  gravity  or 
weight  ?  Or  when  the  balloon,  inflated  with  hydrogen, 
rises  into  the  clouds,  does  the  phenomenon  occur 
through  some  immaterial  agency,  or  because  hydrogen 
is  lighter  than  oxygen  and  nitrogen,  and  is  consequently 
forced  upwards  by  the  pressure  of  these  two  combined 
gases?  And  yet  the  atomic  molecules,  composing 
these  gases,  are  as  much  attenuated  as  the  higher  at 
tenuations  of  a  homo3opathic  medicine.  Science  is 
even  progressed  so  far,  that  we  can  now  compress  cer 
tain  gases,  like  the  carbonic  acid  gas,  &c.,  into  an 
actual  solid  body. 


DOCTRINES  R INSPECTING   A   VITAL  PRINCIPLE,  ETC.          85 

Spallanzani,  Prevost  and  Dumas  have  proved,  that 
if  three  grains  of  the  fecundating  fluid  of  a  frog  be 
dissolved  in  a  pound  of  water,  a  single  drop  of  this 
solution  is  sufficient  to  vivify  many  thousands  of  eggs 
by  simple  contact,  and  yet  this  globule  of  water  only 
contains  2,994,687,500th  part  of  a  grain  !  In  this  case 
an  infinitesimal  quantity  of  matter  has  impressed 
other  crude  substances  by  contact,  in  such  a  manner 
as  to  produce  visible  changes  in  these  substances, — a 
new  action,  and  one  the  most  wonderful  in  nature — 
life.  And  the  mtalist  of  the  old  and  the  dynamist  of 
the  new  school,  would  attribute  this  phenomenon  to 
some  mysterious  vital  or  dynamic  influence :  but  can 
these  minute  atoms  of  fluid  be  annihilated  or  termed 
vital,  dynamic,  spiritual  or  immaterial  properties  of 
the  fluid,  and  the  effects  resulting  from  their  contact 
with  the  eggs,  vital,  dynamic  or  spiritual  effects? 
Because  we  cannot  handle,  smell  or  taste  the  atoms 
dissolved  in  the  globule  of  water,  shall  we  assert  that 
some  mysterious  change  has  been  wrought  upon  this 
material  substance,  and  that  therefore  it  is  not  sub 
ject  to  the  ordinary  laws  of  matter,  but  must  operate 
in  a  spiritual  manner  ?  Common  sense  forbids. 

If  we  take  the  thousandth  part  of  a  grain  of  an  or 
ganized  substance  and  submit  it  to  the  lens  of  a  pow 
erful  microscope,  we  behold  all  the  separate  parts  of 
its  organization,  and  containing  within  itself  innumer 
able  distinct  nuclei,  which  may  be  again  subdivided 
into  perfectly  organized  molecules,  until  the  micro 
scope  can  no  longer  appreciate  the  separate  particles ; 
and  yet  no  one  supposes  that  the  substance  ever  be 
comes  annihilated  or  spiritualized.  Even  one  part  in 
ten  thousand  of  chloroform,  may  be  detected  in  the 
blood,  by  converting  it  at  a  red  heat  into  chlorine 
and  hydrochloric  acid.  How  true  then  the  axiom  of 
Lavoisieur,  Nothing  is  lost,  nothing  is  created. 

Away  then  with  all  unmeaning  expressions,  like 
medicinal  spirit,  vital  power,  dynamization  ;  lefc  us  own 
our  ignorance  respecting  the  precise  changes  which 
drugs  undergo  by  trituration  and  succussion,  and  their 
exact  methodus  modendi,  and  no  longer  imitate  allo 
pathy,  by  resorting  to  spiritual  subterfuges,  in  order  to 


36  THERAPEUTICS. 

give  some  explanation  of  the  great  facts  which  Hah- 
nemann  has  discovered,  but  which  cannot  yet  be  fully 
explained  or  understood. 


CHAPTER   IV. 

THERAPEUTICS. 

At  the  present  time,  there  exists  no  uniform  or  ge 
neral  system  of  therapeutics,  because  there  is  no  the 
ory  of  disease  in  which  universal  confidence  is  re 
posed.  The  medical  world  being  divided  into  several 
distinct  schools,  each  inculcating  different  doctrines 
concerning  pathology  and  the  methods  of  cure,  and 
all  endeavouring  to  sustain  their  favourite  systems, 
without  much  regard  to  accuracy  respecting  facts,  or 
to  logic  in  their  inductions,  it  is  not  surprising  that  the 
science  of  medicine  is  so  often  looked  upon  by  the 
public  with  distrust  and  disrespect.  We  behold  the 
vitalist,  denouncing  the  doctrines  of  the  chemist  and 
mechanician,  as  inconsistent  and  highly  dangerous  in 
practical  operation,  \vhile  all  agree  in  ridiculing  that 
system  which  is  alone  founded  on  accurate  observa 
tion  of  facts,  homoeopathia. 

It  is  doubtless  true  that  many  new  and  valuable 
ideas  may  be  derived  from  each  of  these  conflicting 
schools  by  the  medical  philosopher,  whose  sole  object 
is  truth.  Indeed,  the  coincidence  of  opinion  between 
the  father  of  homoeopathia  and  many  of  the  most 

S [-eminent  advocates  of  the  vita)  theory,  like  Paine, 
ichat,  Philip,  &c.,  in  regard  to  physiology  and  pa 
thology,  is  remarkable.  These  eminent  authors  not 
only  agree  respecting  the  "  properties  and  laws  of 
healthy  beings,"  but  they  concur  as  to  the  changes  and 
modifications  which  take  place  in  diseased  states  of 
the  organism.  Although  they  entertain  totally  differ 
ent  views  concerning  the  practical  application  of  re- 


THERAPEUTICS!.  37 

medics,  it  will  be  observed  that  the  allopath  often 
adopts  the  precept  "  similia  similibus"  in  effecting 
his  cures. 

Nor  are  there  men  wanting, — men  who  stand  high 
in  the  ranks  of  allopathy, — who  unhesitatingly  place 
the  pathological  and  therapeutical  doctrines  of  ho 
moeopathy,  far  above  those  of  either  the  chemical  or 
physical  schools. 

Thus,  Paine,  in  his  "  Institutes  of  Medicine,"  ob 
serves,  "  It  is  due  to  truth  (fiat  justitia  mat  coduni), 
that  the  physiologist  concede  to  the  homcBopath  that 
his  hypothetical  views  may  be  directed  by  an  en 
lightened*  understanding  of  the  properties  and  laws 
of  healthy  beings.  Upon  this  ground,  indeed,  his 
hopes  can  alone  repose  ;  and  even  his  doctrines  in 
pathology  and  therapeutics  are  a  thousandfold  better, 
more  rational,  more  consistent,  more  conducive  to 
health  and  to  life,  than  any  or  all  of  the  tenets  of  the 
chemical  or  physical  schools." 

We  shall  not  be  surprised  at  this  concession,  when 
the  opinions  of  Hahnemann  are  contrasted  with  those 
of  many  allopathic  authors  who  have  written  since 
his  day. 

The  vitalists  hold,  "  that  all  disease  consists  in  a 
modification  of  the  vital  properties  and  a  consequent 
change  of  function,  and  is,  therefore,  only  a  variation 
of  the  natural  states  ;  that  the  artificial  cure  consists 
in  a  restoration  of  these  properties  and  functions  by 
making  upon  the  former  certain  impressions  which 
enable  them  to  obey  their  natural  tendency  to  a  state 
of  health  ;  that  remedial  agents  of  positive  virtues 
operate  like  the  truly  morbific,  but  less  profoundly  in 
their  therapeutical  doses,  and  that  the  philosophy  of 
their  cure  consists  in  establishing,  in  a  direct  manner, 
certain  morbid  alterations  in  the  already  diseased  pro 
perties  and  actions  of  life,  which  are  more  conducive 
to  the  natural  tendency  that  exists  in  the  vital  pro 
perties  to  return  from  a  morbid  to  their  natural  states." 
(Paine.) 

Hahnemann  and  many  of  his  disciples  also  suppose 
that*  "  it  is  solely  the  morbidly  affected  vital  principle 

*  Hahnemann's  Organon. 


38  THERAPEUTICS. 

which  brings  forth  diseases  ;  that  in  disease  this  spon 
taneous  and  immaterial  vital  principle,  pervading  the 
physical  organism,  is  primarily  deranged  by  the  dy 
namic  influence  of  a  morbific  agent,  which  is  inimical 
to  life.  Only  this  principle,  thus  disturbed,  can  give 
to  the  organism  its  abnormal  sensations  and  incline  it 
to  the  irregular  actions  which  we  call  disease." 

So  also  of  the  operation  of  remedies,  Hahnemann 
has  it,  "  that  the  brief  operation  of  the  artificial  mor 
bific  powers,  which  are  denominated  medicinal,  al 
though  they  are  stronger  than  natural  diseases,  ren 
ders  it  possible  that  they  may,  nevertheless,  be  more 
easily  overcome  by  the  vital  energies,  than  the  latter, 
which  are  weaker.  Natural  diseases,  simply  because 
of  their  more  tedious  and  burdensome  operation,  can 
not  be  overcome  by  the  unaided  vital  energies,  until 
they  are  more  strongly  aroused  by  the  physician, 
through  the  medium  of  a  very  similar,  yet  more  pow 
erful  morbific  agent — (a  homoaopathist  medicine). 
Such  an  agent,  upon  its  administration,  urges,  as  it 
were,  the  instinctive  vital  energies,  and  is  substituted 
for  the  natural  morbid  affection  hitherto  existing. 
The  vital  energies  now  become  affected  by  the  medi 
cine  alone,  yet  transiently ;  because  the  medicinal 
disease  is  of  a  short  duration." 

The  vitalists  of  both  schools  also  suppose  that  natural, 
morbific  and  remedial  agents,  possess  certain  peculiar 
and  distinct  properties  which  enable  them  to  exercise 
an  influence  only  on  particular  parts  of  the  system, 
through  the  means  of  particular  nerves;  "passing 
over,  in  the  fulfilment  of  this  law,  various  intermediate 
nerves  of  more  direct  anatomical  connection."  (Paine). 

Although  we  are  not  advocates  of  the  vital  theory, 
yet  it  must  be  conceded  that  this  principle  of  elective 
affinity  is  so  universal,  as  applied  to  the  operation  of 
morbific  and  remedial  agents,  that  the  influence  which 
any  substance  of  either  class  exerts  upon  the  organ 
ism,  may.  with  propriety,  be  denominated  its  specific 
effect.  The  miasms  of  plague,  of  intermittent,  yellow, 
and  certain  other  fevers ;  the  infection  of  conta 
gious  diseases ;  the  virus  of  hydrophobia,  syphilis, 
gonorrhea,  &c.,  all  produce  peculiar  and  specific 
effects  upon  the  system.  Each  of  these  substances 


THERAPEUTICS.  39 

possesses  the  property  of  selecting  that  tissue  for 
which  it  has  an  affinity,  and  of  expending  its  entire 
primary  action  upon  the  particular  part  selected. 

It  is  owing  to  .this  specific  law,  that  medical  men 
have  been  able  to  classify  diseases ;  to  predict  with 
certainty,  that  exposure  to  the  influence  of  particular 
morbific  agents,  under  certain  circumstances,  will 
give  rise  to  abnormal  action  in  certain  parts,  attended 
with  a  definite  and  uniform  train  of  symptoms. 

It  is  also  in  virtue  of  this  specific  law,  that  medi 
cines  may  be  administered  which  operate  with  cer 
tainty  upon  particular  tissues  and  organs,  and  effect 
those  primary  and  sympathetic  modifications  in  dis 
eased  states  of  the  organism,  which  enable  nature  to 
bring  about  safe  and  speedy  cures. 

One  of  the  chief  objections  urged  against  the  thera 
peutical  doctrines  of  homoeopathia,  is  the  supposed 
"  fallacy  of  reasoning  from  the  effects  of  remedial 
agents,  upon  healthy  to  morbid  conditions."  *  The 
reason  adduced  for  this  opinion,  is  the  fact  that  dis 
eased  parts  become  modified  in  their  action,  and  far 
more  susceptible  to  the  operation  of  remedies,  than 
when  healthy.  This  last  statement  is  doubtless  true, 
and  it  stands,  as  we  shall  endeavour  to  show,  at  the 
foundation  of  the  homoeopathic  method  of  administer 
ing  medicines. 

Although  the  axiom,  "  contraria  contrariis  opponen- 
da"  is  almost  universal  among  the  different  schools  of 
allopathia,  so  far  as  theory  is  concerned,  yet  in  prac 
tice,  the  principle  "  similia  similibus  curantur"  is,  as 
we  have  before  observed,  not  unfrequently  adopted. 

In  order  that  a  clear  understanding  may  be  acquir 
ed  of  the  manner  in  which  medicines  operate,  as  ex 
hibited  by  the  old  and  new  schools,  we  shall  attempt 
to  demonstrate  : — 

1st.  That  most  morbific  and  remedial  agents  operate 
specifically  and  with  much  uniformity,  both  in  health 
and  disease,  as  causative  and  curative  agents. 

2d.  That  all  drugs  produce  upon  the  human  body 
primary  and  secondary  effects,  the  first  of  which  ap 
pear  speedily,  and  when  the  dose  has  not  been  exces- 

*  Paine's  Institutes  of  Medicine. 


40  SPECIFIC    EFFECTS    OF 

sive,  are  of  short  duration,  and  are  then  succeeded  by 
the  second,  which  are  of  an  opposite  character,  and 
permanent. 

3d.  That  in  disease,  the  susceptibjlity  of  the  affect 
ed  parts  to  the  action  of  remedies,  is  vastly  greater 
than  of  the  same  parts  when  in  health. 

4th.  That  medicines,  \vhen  administered  in  a  crude 
form  and  in  large  doses,  according  to  the  doctrines  and 
ordinary  practice  of  the  old  school,  whether  applied 
directly  to  the  diseased  organ  or  tissue,  or  to  a  heal 
thy  structure  remote  from  the  diseased  part,  are  not 
only  incompetent  to  eradicate  disease  in  a  safe  and 
speedy  manner,  but  generally  serve  to  aggravate  the 
already  existing  symptoms,  and  by  superinducing  ad 
ditional  medicinal  disease,  complicate,  to  a  serious  ex 
tent,  the  original  natural  affection. 

5th.  That  when  a  curable  natural  disease  has  been 
excited  in  the  organism,  attended  with  a  definite  train 
of  morbid  symptoms,  a  medicine  capable  of  causing 
(in  large  doses)  a  similar  series  of  symptoms,  in 
health,  will  become  speedily  curative  of  such  natural 
disease,  if  administered  in  the  attenuated  doses  of 
homoeopathy. 


CHAPTER  V. 

SPECIFIC  EFFECTS  OF  MORBIFIC  AND  REMEDIAL 
AGENTS. 

All  are  aware  that  the  naturalpoisons  of  certain  ani 
mals  ;  the  virus  of  hydrophobia,  syphilis,  gonorrhoBa  and 
sycosis ;  the  miasms  of  plague,  and  of  yellow,  typhus 
and  intermittent  fevers ;  the  infection  of  contagious 
diseases,  &c.,  exercise,  when  introduced  into  the  cir 
culation,  specific  effects  upon  the  human  system,  and 
give  rise  to  definite  and  easily  recognised  symptoms. 

There  are  other  morbific  agents,  like  intense  and 
protracted  heat  and  cold,  atmospheric  vicissitudes, 
excessive  physical  and  mental  exertion,  violent  emo 
tions,  &c.,  that  operate  in  a  more  general,  but  not  less 


MORBIFIC    AND    REMEDIAL    AGENTS.  41 

specific  manner.  Their  operation,  when  carried  so  far 
as  to  become  morbific,  induces  debility  of  the  nervous 
system ;  loss  of  irritability  in  the  capillary  vessels, 
which  makes  them  incapable  of  excluding  the  red  glo 
bules,  and  as  a  consequence,  developing  augmented 
heat,  swelling,  redness,  and  pain. 

Eberle,  in  his  Practice  of  Medicine,  asserts  that 
"  the  influence  of  almost  every  agent,  whether  morbi 
fic  or  medicinal,  appears  to  possess  a  kind  of  elective 
affinity  for  some  particular  organ  or  structure  of  the 
organization."  This  fact  is  so  apparent,  in  regard  to 
morbific  agents,  that  it  scarcely  requires  notice ;  but 
there  are  many  authors  who  still  entertain  doubts  re 
specting  the  specific  action  of  medicines.  An  attentive 
examination  of  the  following  facts,  must,  however, set 
tle  the  question  satisfactorily  in  the  minds  of  all  im 
partial  inquirers. 

Remedial  agents  operate  in  the  same  specific  man 
ner,  both  in  health  and  in  disease  ;  but  with  the  dif 
ference  that  in  the  latter  condition,  only  a  very  minute 
quantity  of  the  specific  agent  is  requisite  to  produce  a 
salutary  impression,  on  account  of  the  augmented  sus 
ceptibility  to  remedial  impressions,  which  diseased 
parts  acquire. 

1.  "  A  medicine  administered  in  certain  doses,  and 
during  a  certain  period  of  time,  can  produce  patholo 
gical  lesions  analagous  to  those  that  characterize  cer 
tain  diseases." 

2.  "  This  same  medicine,  given  to  a  healthy  indivi 
dual,  on  the  same  principles,  produces  the  character 
istic  symptoms  of  the  diseases  whose  pathological  le 
sions  it  gives  rise  to." 

3.  "  This  medicine  is  a  specific  of  these  same  dis 
eases." 

4.  "  Specificity  is  not  therefore  an  isolated  fact,  but 
the  law  which  should   guide  medical  treatment." — 
[Des  Specifiques  en  Medecine,  Paris,  1847  ;  par  L.  J.  J. 
Molin.] 

The  experiments  of  Majendie,  Blake,  Pereira,  Rau, 
Liebig,  Miiller,  Orfila,  Griesselich,  Molin,  Matteucci, 
and  Philip,  prove  conclusively,  that  most  morbific  and 
remedial  agents  produce  their  effects  after  having 
been  absorbed  into  the  blood.  It  has  also  been  proved 


42  SPECIFIC    EFFECTS    OF 

with  equal  certainty,  that  foreign  substances,  when 
absorbed  into  the  circulation,  are  conveyed  to  those 
structures  for  which  they  have  a  special  affinity,  and 
there  make  a  specific  impression,  which  modifies  the 
function  of  the  part,  according  to  the  nature  of  the 
agent  and  predisposition  of  the  individual.  The  blood 
serves  as  the  conducting  medium  merely,  and  if  the 
absorbed  substances  do  not  possess  the  power  of  exer 
cising  an  influence  upon  any  tissue,  they  may  continue 
to  circulate  through  the  lungs  until  the  inspired  air 
gradually  neutralizes  them,  or  they  may  remain  for  an 
indefinite  length  of  time, (as  sometimes  happens  in  cases 
of  hydrophobic  virus  and  fever  miasms,  without  affect 
ing  the  system.)  and  yet  retain  their  activity.  The  rea 
son  of  this  may  be,  that  the  tissues  upon  which  they  act, 
are  in  so  perfect  a  state  of  vigour,  as  to  be  able  to  resist 
the  power  of  the  noxious  agent,  until  some  cause  shall 
enfeeble  the  part  to  be  affected,  and  thus  predispose 
it  to  receive  the  injurious  impression. 

It  will  not  be  denied,  that  both  in  healthy  and  dis 
eased  states  of  the  organism,  cantharides,  copaibiss, 
cubebs,  the  turpentines,  juniper,  squills,  colchicum, 
digitalis,  apis,  mel,  cajuputi,  and  most  other  diu 
retics,  produce  their  effects  by  acting  directly,  or 
specifically,  upon  the  kidneys,  as  topical  irritants ; 
that  the  preparations  of  mercury,  nitric  acid,  iodine, 
&c.,  exercise  a  direct  and  specific  action  upon  the 
glands,  mucous  membranes,  and  skin  ;  that  senega, 
phosphorus,  ipecacuanha,  tartarized  antimony  (whe 
ther  taken  into  the  stomach  or  injected  into  the 
veins),  and  many  of  the  resins,  exercise  a  specific 
action  upon  the  lungs  ;  that  aloes,  gamboge,  colo- 
cynth,  act  specifically  upon  the  stomach  and  rectum, 
while  senna,  rhubarb,  scammony,  jalap,  and  certain 
other  cathartics,  spend  their  effects  upon  all  portions 
of  the  intestinal  canal ;  that  ergot,  savin,  pulsatilla, 
madder,  tansy,  &c.,  operate  specifically  upon  the 
uterus  ;  that  belladonna,  opium,  stramonium,  strych 
nia,  hyoscyamus,  conia  and  coffea,  impress  speci 
fically  some  portion  of  the  nervous  system  ;  and,  in  a 
word,  that  almost  every  drug  impresses  certain  tis 
sues  in  preference  to  others,  and  that  a  knowledge  of 
the  manifestations  to  which  these  different  impres- 


MORBIFIC  AND  REMEDIAL  AGENTS.  43 

sions  give  rise,  can  alone  enable  us  to  combat  dis 
eases.  That  the  above  enumerated  substances  are 
actually  absorbed,  and  exert  a  topical  effect,  is  appa 
rent  from  the  fact  that  they  have  often  been  detected 
in  the  blood,  secretions,  excretions,  and  even  the  solids 
of  the  body. 

It  is  asserted  by  Flourens,  "  that  opium  acts  speci 
fically  on  the  cerebral  lobes ;  that  belladonna,  in  a 
limited  dose,  affects  the  tubercula  quadrigemina,  and 
in  a  larger  dose  the  cerebral  lobes  also  ;  that  alcohol, 
in  a  limited  dose,  acts  exclusively  on  the  cerebellum, 
but  in  a  larger  quantity,  it  affects  also  neighbouring 
parts  ;  and,  lastly,  that  nux  vomica  more  particularly 
affects  the  medulla  oblongata."  He  also  states, 
"that  in  birds  it  is  possible  to  observe,  through  the 
cranium,  changes  of  colour  (some  alterations  in  the 
vascular  condition  of  the  parts)  which  these  agents 
effect  in  the  brain." 

Pereira,  in  his  Materia  Medica,  also  declares  that 
"the  ammoniacal,  empyreumatic,  and  phosphoric 
stimulants,  containing  ammonia  and  its  salts,  the 
empyreumatic  oils,  phosphorus,  musk,  and  casto- 
reum,  all  agree  in  producing  a  primary  and  specific 
effect  on  the  nervous  system,  the  energy  and  activity 
of  whose  functions  they  exalt.  On  account  of  their 
specific  influence  over  the  nervous  system,  they  are 
administered  in  various  spasmodic  or  convulsive  dis 
eases,  especially  in  hysteria,  and  also  in  epilepsy  and 
chorea.  The  beneficial  influence  of  some  of  the  vege 
table  tonics  (as  cinchona)  in  intermittent  diseases, 
should  probably  be  referred  to  the  specific  effects  of 
these  agents  on  the  nervous  system.  The  prepara 
tions  of  arsenic,  silver,  copper,  bismuth,  zinc,  &c., 
are  usually,  but,  as  I  think,  most  improperly,  denomi 
nated  tonics.  They  are  agents  which,  in  small  and 
repeated  doses,  as  well  as  in  large  and  poisonous 
doses,  specifically  affect  the  nervous  system." 

We  are  also  assured  by  Liebig,  in  his  work  on 
animal  chemistry,  that  *'  we  can  by  remedial  agents 
exercise  an  influence  on  every  part  of  an  organ  by 
substances  possessing  a  well  defined  chemical  ac 
tion." 

It  will  be  observed  that  we  have  adopted,  in  part. 


44  SPECIFIC    EFFECTS    OF 

the  views  of  Miiller,  in  regard  to  the  operation  of 
morbific  and  remedial  agents.  This  distinguished 
physiologist  supposes  that  the  blood  is  only  the  "  ve 
hicle  of  introduction,"  and  that  as  it  passes  through 
the  tissues  of  different  organs,  the  medicinal  particles 
with  which  it  is  impregnated  "  act  on  one  or  more 
parts  which  are  endowed  with  a  peculiar  suscepti 
bility  to  their  influence.  He  also  supposes  "that  a 
change  is  effected  in  the  composition  of  the  organic 
matter  of  the  part  acted  on." 

That  medicinal  substances  induce  modifications  in 
the  functions  of  the  organs,  by  topical  action,  is 
proved,  as  we  have  before  observed,  from  the  fact 
that  the  medicinal  particles  are  often  found  in  the 
excretions  of  the  affected  part.  The  inference  must 
follow,  from  a  careful  consideration  of  all  the  facts 
bearing  upon  the  subject,*  that  the  functions  of  the 
organism  are  generally  morbidly  altered  by  the  direct 
action  of  noxious  substances. 

In  regard  to  the  mode  in  which  these  substances 
operate,  we  suppose  that  their  primary  impression  is 
made  upon  the  sentient  extremities  of  the  nerves,  im 
pairing  their  integrity,  and  rendering  them  incapable 
of  conducting  the  spiritual  stimulus  (which  is  an  es 
sential  condition  of  irritability)  to  the  extreme  vessels. 

It  must  be  borne  in  mind,  that  in  all  inflammations, 
the  capillaries  are  the  "  instruments  of  disease  ;"  that 
the  primary  impressions  of  all  deleterious  agents  are 
made  upon  these  delicate  structures,  and  that  all  of 
our  remedies  must  be  directed  with  reference  to  the 
state  of  these  vessels,  in  curing  disease.  "Upon  these 
vessels  all  remedial  agents  exert  their  curative  effects, 
whether  by  their  direct  action,  or  through  the  in 
strumentality  of  the  nervous  power." — (Paine). 

The  extreme  terminations  of  the  nerves  are  so 
highly  impressible,  that  the  very  minutest  quantity  of 
a  specific  agent  is  capable  of  producing  prompt  and 
decided  effects,  while  the  same  agent  would  prove 
powerless,  if  applied  to  the  larger  nerves.  Thus  it  is 

*  For  further  proofs  respecting  the  doctrine  of  absorption  and  topical 
action  of  drugs,  see  the  experiments  of  M filler,  Tiedemann,  Gmelin, 
Majendie,  Matteucci,  Liebig,  Ran,  Flourens,  Dutrochet,  Blake,  Herring, 
Mayer,  Christison,  Orfila,  and  Dumas. 


MORBIFIC    AND    REMEBIAL    AGENT??.  45 

that  imponderable  substances  and  mental  emotions 
are  so  often  the  causes  of  disease.  Here  we  have  one 
reason,  also,  why  medicines,  when  administered  ho- 
moeopathically,  produce  those  happy  modifications 
in  the  affected  parts  which  dispose  them  so  speedily 
to  recovery.  In  connection  with  this,  if  we  take  into 
consideration  the  extreme  sensibility  which  diseased 
parts  acquire  to  the  operation  of  medicinal  agents, 
we  shall  be  unable  to  doubt  the  propriety  of  ad 
ministering  medicines  according  to  the  homoeopathic 
method. 

Miiller  supposes  that  when  impressions  are  made 
by  specific  substances,  "  changes  are  effected  in  the 
composition  of  the  organic  matter  of  the  parts  acted 
on."  Of  this,  however,  there  is  no  satisfactory  evi 
dence.  On  the  contrary,  we  know  positively  that 
very  many  cases  of  disease  occur  without  giving 
rise  to  any  change  whatever  in  the  organic  construc 
tion  of  the  parts  affected. 

One  of  the  first  indications  generally  observable  in 
an  abnormal  state  of  an  organ  or  tissue,  is  a  loss  of 
tone,  or  irritability  and  perverted  function  of  the  ca 
pillary  vessels.  In  the  experiments  performed  upon 
the  blood,  by  Philip.  Alston,  and  Gallois,  it  was  ob 
served  that  the  smaller  vessels  were  the  first  to  suc 
cumb  to  foreign  influences,  and  then,  if  the  potency 
of  the  agent  wrere  increased,  the  larger  vessels  would 
become  affected. 

Now,  when  we  reflect,  that  irritability  is  dependent, 
1st,  upon  a  normal  organization  of  parts  ;  2d,  a  regular 
and  uniform  supply  of  natural  material  stimuli,  the  ar 
terial  blood,  &c.  ;  and  3d,  a  healthy  action  of  the 
mind,  in  order  that  the  spiritual  stimulus  shall  make 
its  due  impression,  we  can  readily  conceive  how  slight 
a  cause,  moral  or  physical,  morbific  or  remedial,  may 
disturb  or  impair  this  irritability,  and  thus  induce  dis 
ease.  "  Every  part  of  the  organism  depends,  for  the 
performance  of  its  proper  functions,  on  the  receipt  of 
arterial  blood  and  of  nervous  influence  ;  so  alterations 
in  the  supply  of  either  of  these  essentials  may  modify 
or  even  suspend  the  functions  of  a  part."  * 

*  Pereira's  Mat.  Med. 


46  SPECIFIC  EFFECTS  OF 

The  nerves  are  simply  the  conductors  of  the  intelli 
gence,  and  so  long  as  their  integrity,  tone,  or  conduct 
ing  power,  remains  unimpaired,  this  essential  condition 
of  irritability  will  remain.  If,  however,  any  cause  acts 
upon  them  in  such  a  manner  as  to  injure  or  destroy 
this  important  property,  the  stimulus  of  the  superin 
tending  spirit,  or  as  the  vitalist  would  say,  the  nervous 
power,  is  not  transmitted,  and,  as  a  consequence,  dis 
ease  must  result  from  the  absence  of  one  of  the  im 
portant  requisites  of  irritability  or  contractility. 

Injurious  impressions  may  be  made  upon  the  ex 
treme  nerves,  either  by  deleterious  matters  absorbed 
into  the  blood,  and  brought  into  direct  contact  with 
them,  or  by  certain  external  applications,  like  electri 
city,  magnetism,  heat,  cold,  and  exercise. 

Inflammation  may  be  excited  by  the  operation  of 
either  of  these  causes,  by  a  primary  effect  upon  the 
sentient  extremities  of  the  nerves,  which  induces  loss 
of  tone  and  conducting  power,  and  as  a  consequence, 
loss  of  irritability  and  resisting  power  in  the  capillaries. 
This  impression  is  not  made,  as  some  theorists  would 
have  it,  upon  an  immaterial  principle,  but  upon  some 
thing  material,  tangible,  and  demonstrable,  viz.,  the 
nerves  themselves. 

Poisons  and  other  noxious  substances,  when  taken 
into  the  blood,  are  rapidly  conveyed  to  all  parts  of  the 
body ;  and  when  they  arrive  at  the  structures,  upon 
which  they  have  a  specific  action,  nature  makes  an 
effort  to  expel  them  through  these  particular  parts.  If 
the  substance  be  active  in  its  effects,  the  impression 
which  is  made  upon  the  minute  nerves  of  the  part, 
will  be  in  a  corresponding  manner  severe.  The  length 
of  time  required  for  foreign  substances  to  produce  their 
effects,  is  extremely  variable.  Some  articles,  like  se 
veral  of  the  salts  of  potash,  juniper,  the  turpentines, 
asparagus,  indigo,  madder,  &c.,  arc  expelled  through 
the  urinary  organs  in  a  few  moments,  while  other  sub 
stances  may  remain  in  the  blood  for  an  indefinite  pe 
riod  of  time,  or  until  some  predisposing  cause  shall 
act  upon  the  system  in  such  a  manner  as  to  augment 
its  susceptibility,  and  place  it  in  a  condition  to  be  affect 
ed  by  the  morbific  agent.  In  some  instances,  the  morbific 
agent  remains  harmless  in  the  circulation,  for  months, 


MORBIFIC    AND    REMEDIAL    AGENTS.  47 

and  even  years,  when  suddenly,  some  tissue  becoming 
enfeebled  and  incapable  of  resisting  the  action  of  the 
specific  agent,  the  disease,  in  all  of  its  violence,  bursts 
forth.  In  cases  like  these,  it  is  quite  evident  that  the 
injurious  impressions  cannot  be  made  upon  the  vital 
properties  of  parts,  for  the  effects  must  be  sooner  pro 
pagated  and  rendered  apparent.  Neither  can  we  sup 
pose,  with  the  advocates  of  the  chemical  hypothesis, 
that  the  constituents  of  the  blood  become  altered  and 
contaminated  with  the  peculiar  miasms  or  virus,  for 
such  blood  introduced  into  the  circulation  of  a  heal 
thy  individual  gives  rise  to  nothing  like  the  original 
disorder,  We  again  repeat,  that  the  blood  is  simply 
the  vehicle  which  conveys  the  poison,  and  that  no  ef 
fects  are  produced,  until  the  structure  for  which  the 
poison  has  the  greatest  affinity  has  become  ready,  from 
some  predisposing  cause,  to  receive  the  impression  of 
the  deleterious  agent,  and  thus  is  specifically  affect 
ed., 

Why  it  is  that  morbific  and  remedial  agents  select 
particular  organs  and  tissues  to  exert  their  action  upon, 
we  do  not  know  ;  but  that  such  is  the  fact,  all  medical 
observers  will  bear  witness.  Nor  is  it  more  surpris 
ing  than  that  some  of  the  natural  fluids,  like  the  urine, 
gastric  juice,  biie,  &c.,  remain  with  impunity  in  some 
parts  of  the  body,  while  if  they  gain  admission  to  other 
parts,  as  the  cellular  substance,  or  peritoneum,  they 
occasion  inflammation,  sloughing,  and  death. 

Some  writers  attribute  the  operation  of  medicines  to 
an  electrical  influence.  "  All  bodies,"  says  Bischoff, 
"  by  contact  with  each  other,  act  as  electrics,  without, 
however,  necessarily  undergoing  any  chemical  chan 
ges.  Therefore,  when  a  medicine  is  applied  to  the  or 
ganism,  its  action  is  electrical."  The  instantaneous 
effects  of  very  minute  quantities  of  hydrocyanic  acid, 
sulphureted  hydrogen,  and  carbonic  acid  gases,  and 
of  strychnia,  conia  and  morphia,  certainly  bear  a  close 
resemblance  to  the  overwhelming  shock  of  lightning, 
and  go  far  to  sustain  this  opinion. 

Whether  remedies  act  as  topical  stimulants,  or  as 
sedatives,  dynamically  or  electrically,  may  admit  of  a 
question  ;  but  it  is  quite  certain  that  their  primary  im 
pressions  are  made  upon  so  mo  portion  of  the  nervous 


48  SPECIFIC    EFFECTS    OF 

system,  and  generally  on  the  extreme  nerves  of  the 
parts  impressed,  and  those  modifications  of  irritability 
produced,  which  exert  either  a  salutary  or  injurious 
influence  over  the  part  acted  on.  Even  in  those  in 
stances  where  the  primary  influence  has  been  exerted 
upon  some  portion  of  the  cerebro-spinal  or  ganglionic 
systems,  the  capillaries  receive  an  almost  simultaneous 
impression  through  the  sympathetic  nerves,  which  at 
once  gives  rise  to  disordered  function  in  these  import 
ant  vessels. 

Absorption  may  take  place  in  almost  every  struc 
ture  of  the  body — lymphatics,  lacteals,  blood  vessels, 
skin,  cellular  substance,  &c.  ;  but  many  circumstances 
exert  an  influence  in  deterring  the  rapidity  of  the  pro 
cess,  as  well  as  the  quantity  absorbed. 

Miiller  asserts  that  "  the  more  the  matters  are  solu 
ble,  divided  and  fitted  for  entering  into  combination 
with  the  organic  juices,  the  more  easily  are  they  ab 
sorbed."  Absorption  also  varies  according  to  £he 
quantity  of  liquid  which  exists  in  the  organism,  and  is 
in  the  inverse  ratio  of  the  plethoric  state  of  the  animal.*' 
Dutrochet  and  Edwards  have  demonstrated  that  ani 
mals  absorb  water  most  rapidly  after  transpiration. 
Majendie  and  Orfila  have  proved  that  dogs  having 
lost  large  quantities  of  blood,  rapidly  absorb  strychnia 
and  die  ;  while  those  into  whose  veins  large  quanti 
ties  of  water  had  been  injected,  remained  unaffected  by 
the  same  amount  of  the  poison.  These  facts  will  en 
able  us  to  understand  why  diseases  are  not  easily  con 
tracted  when  an  individual  is  in  vigorous  health,  or 
after  a  full  meal. 

"  Within  certain  limits,  absorption  is  in  proportion 
to  the  temperature  of  the  absorbing  body,  and  of  the 
body  absorbed."  (Matteucci.)  Therefore,  inflamma 
tions  of  all  kinds,  fevers,  &c.,  facilitate  absorption. 
For  this  reason  it  is,  that  in  acute  inflammatory  diseases, 
the  higher  attenuations  prove  efficient,  which  would 
be  productive  of  no  effect  in  the  ordinary  condition  of 
the  system. 

Although,  therefore,  morbific  or  medicinal  agents 
may  be  absorbed  into  the  mass  of  blood,  on  account  of 
protracted  hunger  and  thirst,  or  other  cause,  it  does 
not  follow  that  anv  manifestations  will  be  apparent; 


PRIMARY  AND  SECONDARY  ACTION  OF  DRUGS.   P  49 

for  if  the  whole  organism  be  in  a  sound  and  vigorous 
-condition,  it  will  resist  the  specific  action  of  the  sub 
stance  for  an  indefinite  period.  Therefore  it  is  that 
certain  poisons  often  remain  latent  in  the  circulation 
for  months,  and  even  years,  without  being  able  to  ex 
ercise  their  specific  action,  until  some  part  of  the  sys 
tem  becomes  disordered  in  such  a  manner  as  to  be  in 
capable  of  longer  resisting  the  noxious  influence.  In 
many  cases  of  absorption  of  morbific  substances,  where 
the  organism  is  healthy,  it  is  probable,  from  their  con 
stant  circulation  through  the  lungs,  where  they  come 
in  contact  with  that  powerful  decomposing  agent,  the 
inspired  oxygen,  that  they  become  neutralized  after  a 
time,  and  their  noxious  qualities  destroyed.  On  the 
contrary,  if  the  following  conditions  are  present,  viz., 
irritation,  inflammation,  fever,  deranged  digestion,  de 
bility  from  loss  of  fluids,  insufficient  nutriment,  &c., 
the  morbific  agent  will  be  absorbed  with  facility,  and 
speedily  produce  its  specific  impression. 


CHAPTER  VL 

PRIMARY  AND  SECONDARY  ACTION  OF  DRUGS. 

HOMOEOPATHY  teaches  that  the  impressions  which 
drugs  produce  upon  the  organism,  in  health  and  in 
disease,  are  analogous  in  their  character.  But  there 
is  this  important  difference  between  healthy  and 
diseased  structures,  that  large  quantities  of  the  drug 
are  required  to  produce  appreciable  impressions  upon 
the  former,  while  the  susceptibility  of  the  latter  is  so 
morbidly  augmented  that  the  most  minute  atoms  of 
the  medicine  are  instantly  effective.  Not  only  so,  but 
even  the  natural  material  stimuli  of  the  structures  can 
not  be  tolerated,  but  become  immediate  and  additional 
sources  of  disease,  and  if  persisted  in,  of  fatal  disor 
ganization. 

If,  then,  we  desire  to  know  the  precise  effects  of 
drugs  in  disease,  it  is  necessary  to  prove  them  by  tak 
ing  large  doses  in  health — doses  sufficiently  large  to 
affect  the  structures  sensibly  and  decidedly.  Even  if 

3 


50  PRIMARY     AND    SECONDARY 

contraria  contrariis  opponenda  be  adopted  as  the  law  of 
practice,  this  is  an  important  discovery,  for  we  may  then 
administer  the  remedies  with  a  full  knowledge  of  the 
parts  they  impress,  and  of  the  exact  symptoms  they 
induce,  and  thus  remove  allopathy  a  single  step  from 
empiricism.  Some  eminent  writers  of  the  old  school 
have  distinctly  recognised  the  importance  of  this  sub 
ject:  Thus,  Dr.  Paris,  in  his  Materia  Medica,  remarks, 
that  "  observation  and  experiment  upon  the  effects  of 
medicine  are  liable  to  a  thousand  fallacies,  unless  they 
are  carefully  repeated  under  the  various  circumstances 
of  health  and  disease,  in  different  climates,  and  on  dif 
ferent  constitutions." 

Professor  Dunglison,  on  the  seventh  page  of  his 
New  Remedies,  says, "  To  treat  disease  methodically 
and  effectively,  the  nature  of  the  actions  of  the  living 
tissues,  in  both  the  healthy  and  morbid  conditions, 
must  be  correctly  appreciated  ;  the  effects,  which  the 
articles  of  the  Materia  Medica  are  capable  of  exerting 
under  both  those  conditions,  must  be  known  from  Ac 
curate  observation,  and  not  until  then  can  the  prac 
titioner  prescribe  with  any  well-founded  prospect  of 


success." 


Pereira  assures  us,  "  that  in  order  to  ascertain  the 
action  of  remedial  agents  on  the  living  body,  it  is 
necessary  that  we  examine  their  influence  both  in 
healthy  and  diseased  conditions.  For,  by  the  first  we 
learn  the  positive  or  actual  power  of  a  medicine  over 
the  body ;  while,  by  the  second,  we  see  how  that 
power  is  modified  by  the  presence  of  disease." — 
(Pereira's  Mat.  Med.  and  Ther.  Vol.  1,  p.  126.) 

Other  equally  distinguished  allopathic  writers  now 
entertain  the  same  views  upon  this  point,  but  without 
taking  into  consideration  some  very  important  circum 
stances  connected  with  the  provings.  We  have  re 
ference  to  the  great  fact  inculcated  by  Hahnemann, 
that  all  drugs  exercise  upon  the  organism  two  effects,  a 
primary  and  a  secondary,  and  that  these  secondary 
effects  are  always  the  reverse  of  the  primary.  A 
knowledge  of  this  truth  will  enable  us  to  classify  both 
the  primary  and  the  curative  results  of  medicines,  and 
thus  more  clearly  to  appreciate  the  phenomena  which 
should  guide  us  \\\  their  application.  The  primary 


ACTION    OF    DRUGS.  51 

symptoms  make  their  appearance  soon  after  the  medi 
cine  has  been  taken  into  the  stomach,  and  continue  for 
a  longer  or  shorter  period,  according  to  the  magnitude 
of  the  dose,  and  the  condition  of  the  health,  after  which 
they  disappear,  and  the  secondary  or  opposite  series 
of  phenomena  manifest  themselves,  and  remain  until 
the  organism  recovers  its  equilibrium.  But  in  a  few 
instances  the  power  of  drugs  is  displayed  in  such  a 
manner  that  these  primary  and  secondary  effects 
appear  in  alternation  for  a  considerable  time,  when  the 
primary  symptoms  yield  to  the  secondary,  or  serious 
organic  derangements  ensue.  The  mode  of  operation 
in  these  instances,  is  probably  analogous  to  that  of  the 
miasm  of  intermittent  fever,  in  producing  alternate 
chills  and  heat.  Medicines  of  this  description  are 
termed  poly  crests. 

No  one  who  has  candidly  tested  the  operation  of 
drugs  with  reference  to  this  law,  can  for  an  instant 
deny  its  truth  and  importance ;  and  the  law  applies 
nT)t  only  to  large  doses  of  drugs,  but  to  every  other 
cause  which  unduly  impresses  the  structures ;  that  is, 
in  such  a  manner  as  to  disturb  that  healthy  balance  in 
the  operations  of  the  organs  which  constitutes  health. 
Let  us  examine  the  ordinary  effects  of  cathartics  in 
health :  first,  the  mucous  membrane  of  the  intestinal  ca 
nal  is  irritated  or  inflamed,  and  the  natural  consequence 
of  inflammation  follows  in  the  form  of  increased 
mucous  and  serous  secretion,  increased  peristaltic  ac 
tion,  and  a  painful  and  loose  state  of  the  bowels  :  this 
is  the  primary  effect.  After  several  thin  discharges 
from  the  bowels,  a  debility  and  a  depression  of  the  parts 
occur  (bearing  an  inverse  ratio  to  the  amount  of 
primary  inflammation)  ;  the  peristaltic  action  becomes 
impaired  or  suspended,  and  constipation  results  as  the 
secondary  effect  of  the  drug. 

There  is  no  exception  to  this  rule,  unless  the  cathar 
tic  operates  so  violently  as  to  produce  a  permanent 
inflammation  and  disorganization  of  the  mucous  mem 
brane,  in  which  case  the  primary  symptoms  may  be 
continuous  and  constitute  a  permanent  affection. 
Even  in  cases  of  this  kind,  however,  partial  reactions 
sometimes  occur  during  the  course  of  the  malady,  and 
secondary  symptoms  are  manifested,  in  the  form  of 


52  PRIMARY    AND    SECONDARY 

constipation  alternating  with  diarrhoea.  These  violent 
primary  symptoms  rarely  continue  beyond  a  few  days 
without  resulting  in  serious  structural  lesion,  or  a 
healthy  and  permanent  reaction. 

The  primary  effects  of  opium,  in  large  doses,  are  to 
induce  sleep,  lessen  nervous  and  muscular  sensi 
bility,  cause  agreeable  dreams,  and  diminish  or  sus 
pend  all  of  the  secretions,  with  the  exception  of  per 
spiration,  which  is  augmented.  If  the  quantity  taken 
has  been  moderately  large,  a  pleasurable  excitement 
for  a  short  time  precedes  the  soporific  influence,  as  a 
primary  symptom.  These  first  results  continue  from 
twelve  to  forty-eight  hours,  according  to  the  magni 
tude  of  the  dose,  when  the  organism  reacts ;  the  ex 
hilaration  is  succeeded  by  depression,  the  sopor  by 
constant  and  prolonged  wakefulness,  morbid  irritation 
of  the  whole  system,  a  return,  in  preternatural  quan 
tities,  of  all  the  secretions  which  had  been  suspended, 
and  a  suppression  of  the  cutaneous  secretion,  whic^Ji 
had  been  morbidly  augmented  ;  and  the  secondary 
effects  of  the  drug  are  thus  manifested. 

So  long  as  diuretics  continue  to  irritate  the  kidneys, 
they  are  forcibly  stimulated  to  pour  out  an  unusual 
quantity  of  urine  ;  but  as  soon  as  the  specific  is 
omitted,  the  organism  reacts  against  the  temporary 
irritation  set  up  by  the  medicine,  and  a  corresponding 
diminution  of  the  urinary  secretion  follows,  until  the 
organ  recruits  from  the  previous  overaction,  and  the 
disturbed  equilibrium  is  restored. 

The  primary  operation  of  stimulants  gives  rise  to 
an  exaltation  of  the  mental  and  physical  powers, 
while  a  corresponding  depression  and  abasement  in 
variably  result  as  secondary  consequences. 

The  primary  operation  of  digitalis,  in  large  doses, 
is  to  retard  the  action  of  the  heart  and  arteries.  The 
reaction  of  the  system  against  the  drug,  or  the  second 
ary  effect,  is  an  augmentation  of  this  action. 

The  primary  symptoms  caused  by  aconite,  are  in- 
tenser  action  of  the  circulatory  vessels  ;  the  secondary 
consequence  consists  of  a  reduction  of  the  pulsations, 
in  some  instances  as  low  as  thirty-five  in  the  minute. 

The  primary  effect  of  intense  cold,  is  to  stimulate 
and  invigorate  the  whole  system  :  and  the  secondary 


ACTION    OP    DRUGS.  53 

results  are  loss  of  muscular  and  mental  energy,  stupor, 
and  death. 

This  law  of  primary  and  secondary  action  applies 
not  only  to  medicinal,  but  to  a  large  proportion  of 
morbific  agents.  On  this  supposition  we  may  readily 
account  for  the  remissions  and  exacerbations  which 
are  observed  in  most  fevers.  It  is  only  when  the 
morbific  influence  has  been  very  active,  and  the  re 
sulting  inflammation  violent,  that  no  reactions  or 
remissions  occur.  It  may  nevertheless  be  set  down  as 
a  general  law,  that  no  structure  of  the  human  body 
can  be  called  into  preternatural  action,  or  stimulated 
beyond  a  given  point,  without  a  speedy  tendency  to 
reaction  on  the  part  of  the  organism.  In  severe  forms 
of  disease,  this  reaction  may  not  be  apparent  for 
weeks,  and  perhaps  until  organic  lesion  occurs  ;  yet, 
sooner  or  later,  some  reaction,  with  secondary  symp 
toms,  manifests  itself.  There  is  a  healthy  point  in  the 
functional  actions  of  the  organs — an  equilibrium,  if  we 
may  be  allowed  the  expression,  of  the  respiratory, 
circulatory,  digestive,  absorbent,  assimilative,  secre 
tory,  and  excretory  functions — which  cannot  be  dis 
turbed  with  impunity.  Stimulate  one  of  these  beyond 
its  natural  point,  and  a  corresponding  depression  must 
necessarily  ensue  before  the  normal  balance  is  re 
stored.  Each  tissue  possesses  only  a  definite  amount 
of  resisting  power,  and  therefore  every  undue  expen 
diture  of  this  power  entails  future  debility.  Nature 
is  constantly  striving  to  maintain  the  functions  in 
their  natural  condition,  and  this  she  accomplishes 
by  inducing  in  the  different  parts  a  reaction  the  re 
verse  of  the  disturbing  cause,  and  bearing  an  inverse 
ratio  to  this  cause.  The  amount  of  strength  and 
resisting  power  which  is  acquired  from  the  food,  &c., 
is  fixed  and  definite  ;  and  this  force  is  expended  in 
limited  and  definite  quantities  throughout  the  econ 
omy,  and  thus  secures  the  healthy  performance  of  the 
functions. 

The  practical  deductions  which  legitimately  arise 
from  these  views  of  this  subject,  are  of  the  most  inte 
resting  character,  as  regards  the  application  of  reme 
dies  ;  for  if  the  ideas  which  have  here  been  adduced 
are  correct,  it  is  plain  that  the  antipathic  doctrine 


54  SUSCEPTIBILITIES    OF    ORGANS,    ETC. 

of  cure  is  erroneous,  while  the  truth  of  the  homoeo 
pathic  becomes  equally  apparent. 


CHAPTER  VII. 

SUSCEPTIBILITIES  OF  ORGANS  AND  TISSUES  TO  THE  IN 
FLUENCE  OF  REMEDIAL  AGENTS,  VASTLY  GREATER  IN 
DISEASE  THAN  IN  HEALTH. 

ONE  of  the  principal  arguments  which  has  been  ad 
duced  against  Hahnemann's  system  of  therapeutics, 
is  the  supposed  fallacy  of  judging  of  the  effects  of 
medicines  in  disease,  from  their  operation  in  health.  It 
is  considered  that  the  modifications  which  occur  in 
what  are  termed  the  "  vital  properties"  of  parts,  in  a 
state  of  disease,  also  alter  the  action  of  remedial  agents 
in  a  corresponding  manner. 

The  fact  is  incontrovertible,  that  tissues  in  a  state 
of  inflammation,  do  acquire  properties  very  different 
from  what  they  possess  in  the  normal  state  ;  but  re 
specting  the  nature  of  these  acquired  properties,  nu 
merous  facts  go  to  prove,  firstly,  that  the  parts  actually 
inflamed,  become  extremely  sensitive  to  the  impres 
sions  of  specific  remedies  ;  and,  secondly,  that  the 
facility  of  absorption  is  promoted  throughout  the  whole 
system.  The  recent  experiments  of  Miiller  and  Mat- 
teucci  have  demonstrated  the  fact,  that  in  proportion 
as  the  tone  of  the  nervous  and  muscular  systems  be 
comes  impaired,  or  inflammation  obtains,  up  to  a  cer 
tain  point,  just  in  the  same  ratio  will  absorption  be 
promoted  and  foreign  agents  exercise  their  influence. 

We  have  seen  that  inflammation  consists  in  a 
"  congestion  of  the  capillaries,"  induced  by  debility,  and 
the  want  of  resisting  power  in  these  structures,  to  ex 
clude  the  arterial  blood,  and  that  the  effects  of  inflam 
mation  of  a  particular  organ  upon  the  general  system, 
are  lassitude,  pains,  and  other  symptoms  which  indi 
cate  diminished  nervous  and  muscular  energy.  That 
condition,  therefore,  which  is  termed  erethism,  is  not, 
as  is  sometimes  supposed,  indicative  of  increased  ner 
vous  energy,  but  results  directly  from  loss  of  strength. 

In  health,  the  capillary  vessels  possess  the  power  of 


SUSCEPTIBILITIES    OF    ORGANS,    ETC.  55 

excluding  all  of  those  constituents  of  the  blood  except 
the  colourless  fluid  which  is  their  natural  stimulant. 
Although  the  capacity  of  these  minute  tubes  is  suffi 
ciently  large  to  admit  the  red  globules  with  ease,  yet 
they  are  endowed  with  a  peculiar  property  which 
enables  them  to  resist  their  entrance. 

Any  cause,  therefore,  capable  of  impairing  this 
natural  irritability,  becomes  a  source  of  debility  and 
inflammation. 

It  has  been  proved  that,  in  health,  most  medicinal 
substances  may  become  absorbed  into  the  blood  ;  but 
unless  they  possess  some  peculiarly  noxious  qualities, 
they  will  act  upon  those  parts  for  which  they  have  a 
specific  affinity,  and  be  thrown  off  in  the  form  of  excre 
tions,  causing  in  their  passage  through  the  structure 
on  which  they  act,  only  a  slight  and  perhaps  unappre- 
ciable  irritation. 

When  taken  in  disease,  these  same  substances  are 
absorbed  with  far  greater  facility,  and  exercise  the 
same  specific  affinity  for  particular  parts  as  in  health  ; 
but  with  the  difference,  that  they  make  impressions 
upon  the  inflamed  tissues,  far  more  energetic  and 
strongly  pronounced,  than  when  taken  in  a  healthy 
state  of  the  organism.  Nor  is  this  augmented  suscep 
tibility  to  the  influence  of  remedies,  confined  to  the 
tissues  primarily  affected,  but  the  whole  system  be 
comes  far  more  impressible  than  during  health.  It  is 
a  well  established  law,  that  no  one  structure  can  be 
inflamed,  without  giving  rise  secondarily  to  sympathet 
ic  symptoms  in  other  parts  of  the  economy.  It  mat 
ters  not  whether  the  part  primarily  affected,  be  the 
lungs,  stomach,  skin,  or  any  other  structure,  the  whole 
system  may  be  ultimately  disordered,  through  remote, 
contiguous  or  continuous  sympathy.  The  connection 
between  the  different  parts  of  the  human  body,  through 
the  media  of  the  sympathetic  nerves,  is  so  close  and 
direct,  that  no  organ  can  be  acted  on  by  a  morbific 
agent,  without  developing  secondarily  sympathetic 
symptoms  more  or  less  violent,  according  to  the  nature 
of  the  agent,  the  severity  of  the  primary  impression, 
and  the  constitution  of  the  individual.  All  of  the  or 
gans  are  so  designed  and  constructed  by  the  Supreme 
Architect,  that,  in  health,  a  certain  harmony  of  action 


56  SUSCEPTIBILITIES    OF    ORGANS,    BTGV 

prevails  throughout  every  part  of  the  machine,  caus 
ing  every  function  to  be  executed  with  uniformity,  so 
that  no  disturbance  can  accrue  to  any  single  part, 
without  impairing  this  healthy  equilibrium, 

Paine  advances  the  following  sentiments,  which 
have  a  powerful  bearing  upon  this  subject  Probably 
no  allopath  has  ever  written  whose  theoretical  views 
coincide  so  nearly  with  the  doctrines  of  Hahnemann, 
as  those  of  this  distinguished  author  ;  and  we  only 
wonder  that  their  practical  deductions  should  differ 
so  materially. 

"  It  appears  therefore  to  be  a  most  important  law, 
that  morbid  states  call  into  operation  the  function  of 
sympathy  among  organs,  which,  in  their  natural  state, 
manifest  but  feeble,  and  perhaps  no  direct  relations 
whatever  y  and  that  in  consequence  of  morbid  changes, 
remedial  agents  will  operate  sympathetically  through 
the  stomach,  &c.,  upon  remote  parts,  when  they  would 
have  no  such  effect  in  the  healthy  state  of  the  organs- 
New  vital  relations  being  developed  by  disease,  our 
remedies  continue  to  operate  through  those  acquired 
relations  so  long  as  they  exist." 

Again,  "In  proportion,  therefore,  as  the  susceptibili 
ty  of  the  system  at  large  is  increased  by  morbid 
changes,  or  predisposed  by  morbific  influences,  so,  in  a 
general  sense,  will  the  alterative  action  of  remedial 
agents  be  felt  in  a  corresponding  manner." 

Again,  "  It  is  one  of  the  most  important  laws  in 
medicine,  that  the  susceptibility  of  tissues  and  organs 
to  the  action  of  remedial  agents,  is  more  or  less  affected 
by  disease.  Many  agents  which  operate  powerfully 
in  certain  morbid  states,  and  in  certain  doses,  both 
locally  and  sympathetically,  may  be  perfectly  inert  in 
the  natural  states  of  the  same  organs." 

Finally,  "It  is  worthy  of  repetition,  that  such  is  the 
analogy  between  morbific  and  remedial  impressions, 
that  the  organs  which  sustain  the  former  are  thus  ren 
dered  susceptible  of  the  latter,  when  they  might  other 
wise  be  insensible  to  the  same  remedial  agents,  in 
their  appropriate  remedial  doses.  Take  many  of  the 
most  powerful  agents,  arsenic,  tartarized  antimony, 
iodine,  &c.,  and  when  administered  in  certain  small 
and  repeated  alterative  doses,  they  bring  about  the 


SUSCEPTIBILITIES    OF    ORGANS,   ETC.  57 

cure  of  the  most  obstinate  and  formidable  conditions 
of  disease;  while  the  same  doses  may  not  manifest 
any  action  upon  the  system,  or  on  any  part  of  it,  under 
circumstances  of  health.  This  manifestly  depends 
upon  an  increased  susceptibility  of  the  organic  proper 
ties,  in  their  diseased  conditions,  to  the  action  of  for 
eign  agents,  and  upon  an  increased  disposition  to  un 
dergo  changes.  This  law,  which  unfolds  a  principle 
latent  in  health,  and  by  which  morbid  organic  proper 
ties  acquire  susceptibilities  to  salutary  influences  from 
agents  which  in  health  would  either  produce  no  ef 
fects,  or  lead  to  untoward  results,  and  its  ally,  the 
great  recuperative  principle,  impose  the  highest  obli 
gation  upon  physicians  to  become  medical  philoso 
phers."* 

Most  of  the  positions  laid  down  by  Dr.  Paine,  in  the 
above  quotations,  are  doubtless  correct ;  but  in  all  his 
inductions,  he  is  labouring  under  an  important  error 
in  supposing  that  morbific  and  remedial  agents  exer 
cise  their  influence  only  upon  certain  immaterial  prin 
ciples  or  vital  properties. 

Can  it  be  supposed  that  when  tartarized  antimony 
or  Ipecacuanha  are  taken  into  the  stomach,  in  emetic 
or  diaphoretic  doses,  they  act  upon  an  immaterial  pro 
perty  of  this  viscus,  in  causing  emesis  or  diaphoresis  ? 
Can  it  be  believed  that  the  diuretics,  copaibae,  cubebs, 
turpentine,  &c.,  operate  upon  the  vital  properties  of  the 
urinary  apparatus,  in  producing  diuresis,  or  that  bel 
ladonna,  stramonium,  strychnia,  conia,  alcohol,  and  the 
vapours  of  ether,  or  chloroform,  expend  their  force  upon 
thespiritual  properties  of  the  brain  and  nervous  system  ; 
or  that  the  preparations  of  mercury,  iodine,  &c.,  exer 
cise  their  powerful  influence  upon  the  organism,  by  im 
pressing  immaterial,  imponderable,  or  vital  properties? 
We  think  it  is  more  consistent  with  known  facts  and 
sound  logic,  to  suppose  that  all  such  agents  exert  their 
influence  primarily  upon  the  sentient  extremities  of 
the  nerves,  modifying  the  functions  of  those  parts  which 
they  supply,  increasing  their  susceptibility  to  the  in 
fluence  of  foreign  agents,  and  thus  establishing  inflam 
mation  or  a  new  action. 

*  Paine's  Institutes  of  Medicine. 
3* 


58  SUSCEPTIBILITY    OF    ORGANS,    ETC. 

It  has  been  remarked  by  Paine  and  others,  that  ar 
senic,  antimony,  iodine,  mercury,  etc.,  given  in  certain 
small  and  repeated  doses,  in  disease,  are  productive  of 
decisive  effects,  while  the  same  doses  in  health,  would 
exert  no  appreciable  influence.  For  this  reason,  they 
assert  and  would  have  us  believe,  that  the  conditions 
and  properties  of  diseased  parts  are  so  modified  and 
altered  in  all  respects,  as  to  be  incapable  of  responding 
to  the  action  of  those  medicines  which  operate  specifi 
cally  in  health. 

It  is  quite  certain  that  most  medicinal  substances 
may  be  taken  in  very  small  doses  during  health,  with 
out  any  apparent  effect,  on  account  of  the  power  which 
the  system  then  possesses  of  resisting  the  aggressions 
of  slight  foreign  agents ;  but  if  the  same  substances 
be  taken  in  large  doses,  most  decided,  powerful,  and 
specific  results  \vill  follow  in  all  stales  of  the  system. 
If  taken  in  still  smaller  quantities,  the  effects  are  yet 
perceptible,  but  less  strongly  marked.  These  results 
will  be  unequal  in  point  of  intensity  in  normal  and  ab 
normal  states  of  the  organism,  according  to  the  amount 
of  disease  present ;  but  in  all  instances,  their  specific 
operations  will  be  uniform. 

Tartarized  antimony  and  ipecacuanJia,  in  large  doses, 
both  in  health  and  disease,  exercise  a  specific  influ 
ence  upon  the  stomach,  lungs,  and  skin,  as  is  indi 
cated  by  vomiting  and  augmented  secretions  from  the 
respiratory  organs  and  skin.  In  doses  of  one-sixth  or 
one-eighth  of  a  grain,  no  effect  is  produced  upon  the 
respiratory  muscles  or  stomach,  but  the  influence  is 
yet  visible  upon  the  skin.  If  the  quantity  be  dimin 
ished  still  farther,  even  to  an  attenuation  of  Hahne- 
mann,  the  impression  may  not  be  perceptible,  either 
upon  the  stomach,  lungs,  or  skin,  yet  we  find  them 
capable  of  influencing  the  extreme  nerves  in  a  de 
cided  manner.  It  does  not  follow,  because  a  patient 
does  not  vomit,  purge,  or  sweat,  that  a  medicine  has 
no  effect.  On  the  contrary,  we  know  that  morbific 
agents  give  rise  to  the  most  virulent  diseases  without 
creating  the  slightest  sensation  in  the  system  at  the 
period  when  the  noxious  impression  is  made.  The 
direct  and  sympathetic  effects  of  such  causes  are, 
however,  severe  and  dangerous. 


SUSCEPTIBILITIES    OF    OBGANS,    ETC.  59 

The  experiences  of  a  host  of  honourable  and  scientific 
men  have  proved,  beyond  a  doubt,  that  minute  quanti 
ties  of  medicinal  agents  may  produce  salutary  influ 
ences  in  the  same  manner  ;  and  the  law  obtains  with 
regard  to  all  specific  medicines.  The  effects  in  these 
instances  may  not  indeed  be  sufficient  to  induce 
emesis,  catharsis,  or  other  violent  effects  in  any  part 
of  the  body;  yet  from  the  great  sensibility  of  the 
minute  nervous  ramifications,  they  must  receive  im 
pressions  and  be  modified  in  their  action,  when  the 
trunks,  or  larger  branches  of  nerves,  would  remain 
unaffected.  Who  shall  decide  when  the  quantity  has 
become  too  small  to  produce  an  effect  upon  the  most 
sensitive  parts  of  the  body  ?  Shall  the  allopath,  be 
cause  he  does  not  witness  vomiting,  purging,  or 
sweating;  or  the  homoeopath,  who  from  accurate  ob 
servation  in  numerous  instances,  notes  from  infinitesi 
mal  doses,  prompt  and  decisive  curative  effects? 

To  illustrate  our  meaning  more  fully,  we  will  sup 
pose  a  certain  medicine  possesses  the  power,  when 
given  in  large  doses,  during  health,  of  affecting  a  par 
ticular  tissue.  The  same  substance,  administered  in 
very  small  doses  under  the  same  circumstances,  has 
no  apparent  influence.  If,  now,  the  tissue  for  which  it 
has  a  specific  affinity,  becomes  inflamed,  its  suscepti 
bility  is  so  acute,  that  an  extremely  minute  quantity 
of  the  specific  agent  is  capable  of  making  potent  and 
salutary  impressions. 

The  other  parts  of  the  organism  which  become  dis 
ordered  through  the  media  of  the  sympathetic  nerves, 
also  acquire  an  exalted  sensibility  which  renders  them 
highly  impressible,  and  capable  of  being  acted  upon 
by  infinitesimal  quantities  of  specific  medicinal  agents. 
Homoeopathic  remedies,  as  Paine  has  well  observed 
of  medicines  generally,  act  only  through  these  "  ac 
quired  relations,"  and  their  power  ceases  as  soon  as 
these  acquired  relations  have  been  removed  and 
health  re-established. 

We  shall  appreciate,  then,  the  importance  of  se 
lecting  a  remedy  which  shall  cover,  not  only  the 
symptoms  resulting  directly  Yrom  the  tissue  primarily 
affected,  but  which  shall  embrace  all  of  the  remote 


CO  SUSCEPTIBILITY  OF  ORGANS,  ETC. 

sympathetic  effects.  In  other  words,  we  must  pre 
scribe  for  the  "  totality  of  the  symptoms." 

"  It  will  now  be  apparent,  from  what  has  been  said 
in  the  preceding  section,  how  it  is  that  remedial 
agents  will  call  into  salutary  reacting,  sympathies  in 
various  parts  of  the  body  not  affected  by  disease,  but 
whose  susceptibilities  are  increased  by  morbific  sym 
pathies  reflected  from  the  seat  of  absolute  disease, 
and  upon  which  parts  the  remedial  agents  might 
otherwise  be  inoperative.  Whatever,  too,  may  be  the 
complexities  of  disease,  the  right  remedy  will  be  at 
least  compatible  with  the  whole  condition."  * 

"A  particular  state  of  one  organ,  such  as  inflamma 
tion,  or  a  secreting  action  in  it,  often  causes  the  pro 
duction  of  a  similar  state  in  other  parts."  And,  "  the 
principle  of  the  balance  of  sympathy  teaches  us  how 
we  must  avoid  aggravating  the  morbid  condition  of 
one  organ  by  the  means  which  we  apply  to  another."f 

An  adherence  in  all  cases  to  Hahnemann's  axiom, 
"  similia  similibus,"  in  our  remedial  measures,  is  the 
only  means  by  which  this  last  objection  can  be  ob 
viated  with  any  certainty  or  success. 

It  is  proper  to  remark,  before  concluding  this  chap 
ter,  that  there  are  a  few  apparent,  though  not  real 
exceptions  to  the  principles  which  we  have  advanced. 
A  most  remarkable  one  is  observed  in  the  case  of 
tetanus,  where  enormous  quantities  of  opium,  both  in 
a  crude  form  and  in  tincture,  may  be  administered  by 
the  stomach  or  rectum,  without  producing  any  mark 
ed  effect.  This  fact,  however,  by  no  means  proves 
that  the  susceptibility  of  the  parls  for  which  opium 
is  a  specific,  is  diminished  ;  but  it  proves  only  that  ab 
sorption  is  prevented.  If  opium  is  injected  into  the 
veins,  under  these  circumstances,  it  has  been  found 
by  Majendie,  Orfila,  and  Muller,  that  it  exerts  its 
influence  in  the  same  manner  and  degree  as  when 
taken  during  health. 

We  suppose,  therefore,  that  in  tetanus,  the  lacteals 
and  other  absorbents,  are  in  a  state  of  spasm,  and  thus 
mechanically  exclude  th£  entrance  of  all  substances 

*  Paine's  Institutes  of  Medicine, 
f  Miiller's  Physiology 


ALLOPATHY.  61 

from  their  structure.  In  this  manner,  opiates  and 
other  drugs  are  shut  out  of  the  circulation,  and,  con 
sequently,  cannot  be  brought  into  contact  with  those 
parts  of  the  nervous  system  upon  which  they  exert 
their  specific  force,  and  where  alone  they  possess  the 
power  of  producing  their  legitimate  effects. 

All  cases  of  this  description,  are  simply  apparent 
exceptions  to  the  general  rule,  and  do  not  in  the 
slightest  degree  invalidate  the  general  principles 
which  we  have  advanced. 


CHAPTER  VIII. 
ALLOPATHY. 

It  would  be  very  difficult  at  the  present  time,  to 
give  an  accurate  definition  of  the  above  term.  The 
axiom  which  is  adopted  by  .a  portion  of  the  disciples 
of  the  allopathic  school,  and  upon  which  their  hypo 
thetical  doctrines  are  founded,  is  "  contraria  contrariis 
opponenda."  Although  distinctions  are  recognised 
between  the  antipathic  or  palliative,  the  allopathic  or 
heteropathic,  and  the  chemical,  methods  of  practice, 
yet  in  point  of  fact,  they  may  all,  with  propriety,  be 
resolved  into  one  and  the  same  school.  All  employ 
venesection,  emetics,  purgatives,  diaphoretics,  and 
alteratives,  to  reduce  inflammations  ;  opium  to  allay 
pain  and  suppress  unnatural  discharges ;  bark,  iron, 
brandy,  &c.,  as  tonics ;  blisters,  setons,  moxas,  issues 
and  escharotics  to  produce  counter-irritation ;  revul 
sives,  derivatives,  and  indeed  all  of  those  means  which 
are  termed  allopathic. 

Allopathists  do  not,  however,  uniformly  adhere  to 
any  of  the  above  doctrines,  but  often  unconsciously 
encroach  upon  homoeopathic  ground,  and  by  practis 
ing  according  to  the  law  of  "  similia  similibus"  effect 
their  speediest  and  safest  cures. 

Thus,  rhubarb  and  calomel,  when  administered  in 
large  doses  during  health,  cause  irritation  or  inn1  am- 


62  ALLOPATHY. 

mation  of  the  membranous  tissue  of  the  bowels,  as  is 
indicated  by  griping  pains,  and  discharges  of  watery 
or  mucous  fluids  ;  yet  these  are  favourite  allopathic  re 
medies  for  diarrhoea  and  dysentery  :  copaibse,  cubebs, 
turpentine,  and  cantharides,  when  given  in  large  and 
repeated  doses  in  health,  induce  inflammation  of  the 
mucous  membranes  of  the  urino-genital  apparatus; 
yet  these  specific  medicines    are    almost   invariably 
prescribed    in    the   acute    and  chronic  affections  of 
these  parts  :  ipecacuanha  in  doses  of  twenty  to  thirty 
grains,  is  the  most  common  emetic  of  the  old  school ; 
yet  this  same  school  are  constantly  in  the  habit  of  ad 
ministering  this  drug  in  doses  of  one-twelfth  or  one- 
sixteenth  of  a  grain,  in  cases  of  obstinate  nausea  and 
vomiting,  with  the  most  happy  results  :  inhalations 
also  of  the  particles  of  ipecacuanha,  cause  asthma, 
cough,  dyspnoea,  &c. ;  yet  it  is  a  common  remedy  in 
small    quantities  for  the   cure   of   these   complaints: 
excessive  use  of  alcoholic  liquors  or  opiates,  often  in 
duces  mania  a  potu ;  yet  opium  and  brandy,  which 
exercise  the  same  specific  effect  upon  the  brain,  are 
the  principal  allopathic  cures  of  this  dangerous  ma 
lady  :   the   preparations  of  mercury,  when  given   in 
considerable   quantities,  cause  ulceration  and  some 
times   gangrene   and   sloughing   of   the   mouth    and 
throat,  pains  in  the  muscles  and  bones,  eruptions  upon 
the  skin,  and  inflammation  of  the  bowels,  attended 
with  tenesmus,  and  mucous  and  bloody  stools ;  yet  for 
syphilitic  and  other  ulcerations  of  the  throat,  pains  in 
the  limbs,  eruptions,  and  bowel  affections,  the  use  of 
small  doses  of  this  mineral,  in  some  form,  is  deemed 
indispensable  by  the  allopath.     Sir  Astley  Cooper,  in 
his  Lectures,  observes,*  "  Children  often  contract  sy 
philis  i?i  utero,   and  within  twenty-four  hours  after 
their  entrance  into  the  world,  have  the  palms  of  their 
hands,  the  soles  of  their  feet,  and  the  nates,  covered 
with  copper-coloured  eruptions ;  and  the  nails  begin 
to  peel  off',  and  if  care  be  not  taken,  the  little  patient 
will  sink  under  the  effects  of  the  disease.     In  these 
cases,  you  give  the  mother  a  quantity  of  mercury,  the 
influence   of  which   is   communicated   to   the   child, 

*  Cooper's  Manual  of  Surgery,  by  Castle. 


ALLOPATHY.  63 

through  the  medium  of  the  milk,  and  it  becomes 
cured  of  the  syphilitic  disease."  This  is  excellent 
homceopathic  treatment :  the  mercury  in  this  in 
stance  is  attenuated  in  the  mother's  milk  to  a  very 
great  extent — probably  to  such  a  degree  that  no  ana 
lysis  can  detect  it,  or  any  scales  weigh  it,  and  yet  Sir 
Astley  Cooper  assures  us  that  the  infinitesimal  quan 
tity  of  mercury  which  finds  its  way  to  the  milk  of  the 
mother,  is  sufficient  to  effect  a  speedy  cure  upon  the 
child.  In  this  instance  nature,  instead  of  art,  attenu 
ates  the  drug.  Tartarized  antimony  exercises  a  spe 
cific  effect  upon  the  lungs,  stomach,  and  secretory 
organs,  causing,  according  to  Majendie,  an  inflamma 
tion  or  engorgement  of  the  two  first  named  organs, 
whether  taken  into  the  stomach  or  injected  into  the 
veins ;  yet  this  is  the  sheet-anchor  of  allopathy  in 
pneumonia,  pleurisy,  and  in  the  first  stages  of  gastric 
or  bilious  fevers.  Arsenic  has  a  specific  influence  when 
taken  in  large  doses,  in  health,  upon  the  nervous 
system,  heart,  skin,  and  alimentary  canal ;  and  this  is 
an  important  old-school  remedy  in  neuralgia,  epi 
lepsy,  chorea,  angina-pectoris,  cutaneous  affections, 
and  intermittent  fevers.  When  nitrate  of  silver  is  ab 
sorbed  in  health,  it  makes  a  specific  impression  upon 
the  nervous  system  and  the  corium  ;  allopathists  em 
ploy  it  in  epilepsy,  chorea,  and  in  morbid  sensibility 
of  the  gastric  and  intestinal  nerves.  Large  and  re 
peated  doses  of  nux  vomica  or  strychnia,  taken  in 
health,  produce  "  rigidity  and  convulsive  contrac 
tions"  of  the  muscles  ;  yet  in  cases  of  traumatic  te 
tanus,  strychnia  has  effected  cures  in  the  hands  of  al 
lopathic  physicians,  in  doses  of  TTT  to  ^V  of  a  grain  :* 
its  specific  action  under  all  circumstances,  is  upon  the 
cerebro-spinal  system,  and  thus  its  efficacy  when 
properly  exhibited  in  tetanus,  epilepsy,  chorea  and  hys 
teria.  Belladonna,  taken  in  health,  gives  rise  to  inflam 
mation  of  the  throat  and  a  scarlet  eruption  upon  the 
skin  ;  and  yet  this  remedy  is  highly  extolled  and  ex 
tensively  used  by  many  leading  men  opposed  to  ho 
moeopathy,  as  a  prophylactic  against  scarlatina.  An 

*  See  report  of  tetanus  cured  with  strychnia,  by  Dr.  Fell.    8th  number 
of  N.  Y.  Med.  and  Surg.  Reporter. 


64  ALLOPATHY. 

eruption  resembling  psora  is  often  produced  by  an 
excessive  use  of  sulphur  and  iodine  ;  still  these  are 
the  grand  remedies  in  cutaneous  affections  of  this 
kind.  Pereira  prescribed  prussic  acid  to  a  lady  who 
had  been  suffering  for  months  from  gastrodynia ;  in 
a  few  hours,  to  the  astonishment  of  every  one,  she 
was  quite  well.  "  It  can  hardly  be  imagined,"  says 
Pereira,  "  that  irritation  of  the  stomach  can  be  ra 
pidly  removed  by  a  substance  which  is  itself  an  ir 
ritant"  The  direct  application  of  blisters  to  surfaces 
affected  with  rheumatic,  erysipelatous,  and  other  na 
tural  cutaneous  inflammations,  is  constantly  recom 
mended  at  the  present  time  by  the  Hippocrat  ics. 
"  Erysipelas  and  other  cutaneous  inflammations  may 
be  removed  by  the  direct  action  of  cantharides  upon 
the  part  inflamed.  The  remedial  agent,  in  these 
cases,  varies  the  mode  of  inflammation,  and  thus  in 
troduces  a  modification  in  which  the  properties  of 
life  are  brought  into  recuperative  action"  (Paine 's 
Institutes  of  Medicine)  ;  yet  they  affect  a  superlative 
contempt  for  the  law  of  "  similia  similibus  curantur  ! " 
It  is  from  experience  alone  that  the  old  school  phy 
sicians  have  learned  that  ipecac.,  in  doses  of  TV  to  TV 
of  a  grain,  arrests  nausea  and  vomiting,  and  imparts 
tone  and  vigour  to  the  stomach ;  that  calomel,  in  do 
ses  of  2^  of  a  grain,  is  invaluable  for  the  cure  of  in 
flammation  of  the  mucous  membranes  of  the  bowels: 
"  in  cases  of  inflammation  of  the  mucous  tissue  of  the 
intestines  attended  with  frequent  watery  discharges, 
there  is  nothing  comparable  with  calomel,  in  doses 
varying  from  the  twentieth  to  the  eighth  of  a  grain, 
once  in  four  to  twelve  hours :" — (Paine' s  Institutes  of 
Medicine.)  That  quinia,  in  doses  of  y1^  or  -£•$  of  a 
grain,  is  more  efficient  in  removing  remittent  and  in 
termittent  fevers,  and  as  a  general  tonic  in  diseased 
states  of  the  system,  than  when  exhibited  in  quan 
tities  of  from  one  to  ten  grains  at  a  dose  :  "quinia  in  the 
dose  of  5  or  10  grains,  may  speedily  arrest  an  inter 
mittent  fever  by  its  febrifuge  virtue  ;  but  this  is  bad 
practice,  since,  by  its  associate  tonic  virtue,  it  is 
likely  to  increase  or  to  induce  local  congestions ;  thus 
leaving  the  patient  imperfectly  cured,  and  subject  to 
relapses :  I  have  seen,  in  my  own  family,  the  most 


ALLOPATHY.  65 

formidable  grade  of  remittent  fever,  of  long  duration 
and  attended  with  the  foregoing  complications,  ar 
dent  heat,  thread-like  pulse,  loss  of  mind,  &c.,  and 
where  hope  of  recovery  had  been  abandoned,  yield  to 
less  than  a  grain  of  quinine,  divided  into  sixteen  do 
ses" — (Paine's  Institutes  of  Medicine)  ;  that  strychnia, 
in  very  minute  quantities,  will  cure  tetanus  ;  that  the 
class  of  remedies  denominated  alteratives,  are  capable 
of  producing  powerful  effects  upon  the  organism,  and 
that  too,  in  a  manner  altogether  unknown  and  imper 
ceptible. 

But  how  do  these  physicians  know  that  the  vir 
tues  of  these  medicines  cease  at  these  points?  Have 
they  ever  made  honest  trials  of  them  in  a  pure  form, 
and  in  doses  of  ¥V,  T^,  or  a  still  smaller  proportion 
of  a  grain,  and  learned  from  actual  observation  that 
they  have  then  lost  their  power  of  impressing  diseased 
structures?  We  venture  to  affirm,  never,  or  they 
would  long  since  have  deserted  the  standard  of  allo 
pathy. 

This  leaning  towards  the  modern  theory  is  not 
altogether  confined  to  the  few  practical  cases  which 
we  have  cited,  but  some  of  their  most  eminent  wri 
ters  have  approached  so  near  to  the  views  of  Hahne- 
mann,  that  we  are  at  a  loss  whether  to  rank  their 
theoretical  doctrines  as  homeopathic  or  allopathic. 

The  distinguished  Pereira.  in  his  Materia  Medica 
and  Therapeutics,  \vrites  as  follows  :  "  Unguents  and 
lotions  are  used  in  cutaneous  diseases,  ulcers,  &c. ; 
gargles  in  affections  of  the  mouth  and  throat ;  colly- 
ria  in  opthalmic  diseases  ;  and  injections  into  the 
vagina  and  uterus  in  affections  of  the  urino-genital 
organs.  In  all  such  cases,  we  can  explain  the  therapeu 
tical  effect  in  no  other  way  than  by  assuming  that  the 
medicine  sets  up  a  new  kind  of  action  in  the  part  affected, 
and  that  the  new  action  subsides  when  the  use  of  the 
medicine  is  suspended  or  desisted  from" 

This  explanation  is  the  true  one.  The  medicines 
in  these  cases,  as  welJ  as  in  all  other  instances  where 
appropriate  specific  remedies  are  used,  do  "  set  up  a 
new  kind  of  action  in  the  part  affected,"  creating  a  me 
dicinal  disease  which  supersedes  the  natural  one. 

The  only  fault  we  have  to  urge  against  allopathists 


in  the  treatment  of  tbur  and  analogous  cases,  is, 
thai  they  give  orach  too  large  doses,  and  thus  create 
m  fer  more  wisies*  mcifir  'mil  disease than  is  necessary 
to  bring  about  their  cures.  Notwithstanding,  how 
ever,  their  errors  in  exhibiting  mrdkiiif  i  in  a  erode 
mad  impure  form,  and  in  unnecessarily  large  doses, 
we  must  give  them  the  credit.  (_&rt~  jmstitia  rmaf 
OKfaau)  of  occasionally  timing  dwra.se  (although  un 
wittingly)  in  a  -  rational  and  consistent "  manner. 

Paine,  in  bis  Institutes  of  Medicine,  remarks.  -  thai 
•bin  the  intestinal  mucous  tissue  is  affected  with 
that  caadstiasi  of  disrasr  which  results  in  a  preter- 
namral  watery  *t  en  tion,  aadcosaLii|Hi  at  gwacoations. 
^lled  diarrhoea,  and  rhnharb  is  administered 
-  -  - "  :.  : ; :  -  ~  —  - 

a  way  as  to  determine  an  increase 

.    .  .  . .    .      ;  .  . 

atmttommMstak^tJKimlatarimMttutmeiM 

'"  .-  -..---  '         -  .          •  -  j-  .     .       ::-.-•: 

.    -.    -  -  -       .        -    .        . 

:          . 

rfectt  sm  lie  ritef  properties  ami  mctiau  -of  the 

mrc  tkf  semt  *f  tke  mor^td  cmutitic  ms, 


the  practitioners  of  the 
in  the  treatment  of  many  .uibii  diseases, 
at  homoeopathy,  and  hold  up  their 

iaes  as  philo- 

:---.---      :    -..       _.l   ^':_       . 
too  often  belies  your  profession :  yon 
to  be  aUopaihUte  and  antipathists.  whO e  con- 

the  manner  of 


-L~  ..  :i>:       :--    :.      ::    -.    .-.'z   -y   -  .-    ::.-   - 

retical  doctrwes  which  have  come  to  you  from  rode 
and  dark  1^1  n  ibii  liim  11  whii  b  bsir  nt*  iiml  •  ill 
:;  .-  :  '  -  -.  :•  -..  - ..-  \.  .-:.>-.:_-  -': :  -  .-  -  -.  ^.  I 
hare  stealthily,  and,  doubt  3  ess,  in 
im  wittingly,  abandoned  your  legiti- 
Dand.  and  ptmduet  mptm  the  principles  of  oar 
heresy!  Where  if  your  pride,  where  your 
You  hare  the  boast  of  antiquitv  yon 


A1IXJPATHT.  67 

have  received  your  "  bundle  of  ideas"  from  Hippo 
crates  and  Galen,  to  whom  you  pay  reverence  and 
allegiance  :  you  disdain  innovations,  and  despise  dis 
coveries  and  improvements ;  you  have  withstood  the 
changes  of  more  than  two  thousand  years,  and.  by 
your  powerful  dicta,  have  continually  discouraged  all 
original  induction,  and  endeavoured  to  crush  in  the 
bud  even,-  advancement  in  medical  knowledge. 
Where  is  now  your  former  pride,  that  you  so  often 
practically  abandon  your  time -sacred  axiom,  *  comlrm- 
ri/z  contruriisr  and  adopt  the  new  heresy.  *•  timilia 
similibus  T  Perhaps  the  light  of  modern  science  and 
discovery  breaks,  against  your  will,  through  the  cre 
vices  of  your  unjointed  and  heterogeneous  theories,  or 
you  are  startled  from  your  propriety  by  the  whelming 
accumulations  of  fact  which  Hahnemann  and  his  dis 
ciples  have  displayed  so  bravely  before  the  world : 
or.  possibly,  the  disrespect  and  abuse  of  some  of  the 
most  eminent  and  able  of  your  caste,  has  impaired  all 
confidence  in.  and  respect  for.  your  own  dogmas  and 
their  applications,  and  you  are  at  sea  in  search  of  a 
system.  Are  we  wrong  ?  If  so.  we  have  excuse  in 
the  following,  from  the  distinguished  editor  of  the 
British  and  Foreign  Medical  Review.  Dr.  Forbes, 
\vho  asserts  : 

"  1.  That  in  a  large  proportion  of  the  cases  treated 
by  allopathic  physicians,  the  disease  is  cured  by  na 
ture,  and  not  by  them. 

-  2.  That  in  a  less,  but  still  not  in  a  small  propor 
tion,  the  disease  is  cured  by  nature  in  spite  of  them  : 
in  other  words,  their  interference  opposing  instead  of 
assisting  the  cure. 

-  3.  That,  consequently,  in  a  considerable  propor 
tion  of  diseases,  it  would  fare  as  well  or  better  with 
patients,  in  the  actual   condition  of  the  medical  art, 
as  more  generally  practised,  if  all  remedies,  at  least 
all  active  remedies,  especially  drugs,  were  abandoned. 
We  repeat  our  readiness  to  admit  these  inference- 
just,  and  to  abide  the  consequences  of  their  adoption." 

Beware,  then,  most  ancient  goddess,  survivor  of  all 
thine  earlier  contemporaries — of  alchemy,  and  astrolo 
gy — lest  thou  fall,  and  thy  doctrines,  handed  down 
through  the  dark  ages,  through  the  juggling  temples 


68  ALLOPATHY. 

of  idolatrous  priests,  be  swallowed  up  in  the  deluge 
of  new  facts  and  discoveries  which  the  nineteenth 
century  is  pouring  upon  the  world.  But,  seriously,  it 
is  a  matter  of  no  little  surprise,  that  while  anatomy 
has  made  most  rapid  strides,  unfolding  the  secrets 
pertaining  to  the  most  minute  structures  of  the  ani 
mal  organism ;  while  botany  and  mineralogy  have 
displayed  before  our  eyes  the  wonders  of  the  vegeta 
ble  and  mineral  kingdoms,  and  pointed  out  the  laws 
of  their  formation,  development,  and  even  of  their 
very  existence  ;  while  chemistry  has  grasped  some  of 
the  most  subtle  agents  in  nature,  and  developed  im 
provements  in  the  arts  and  sciences  which  have  con 
tinually  startled  and  astonished  the  world,  as  well  for 
useful  as  for  purely  scientific  results, — medicine,  until 
the  time  of  Hahnemann,  has  been  crushed  under  the 
weight  of  antiquated  doctrines,  and  the  legalized 
power  and  oppression  of  the  schools. 

We  have  thus  far  made  allusion  to  that  part  only 
of  the  allopathic  practice  which  bears  some  approxi 
mation  to  the  correct  method.  In  most  of  the  in 
stances  enumerated,  specific  medicines  are  employed — 
medicines  that  produce  a  similar  state  when  given  in 
health,  to  that  which  they  are  to  cure.  Although 
large  quantities  of  crude  and  impure  drugs  are  used 
in  these  instances,  and  the  medicinal  diseases  are 
thus  rendered  violent  and  complicated,  still  it  must  be 
admitted  that  occasional  cures  are  accomplished. 

But  we  come  now  to  a  more  interesting  and  momen 
tous  part  of  our  subject.  It  becomes  our  duty  to  lay 
before  our  readers  the  doctrines  and  practice  of  allo 
pathy,  as  they  actually  exist ;  to  note  their  many  in 
consistencies,  and  to  point  out  some  of  the  innumerable 
evils  which  they  entail  upon  mankind. 

We  have  seen  that  in  the  treatment  of  disease,  the 
old  school  physicians  make  an  indiscriminate  use  of 
the  palliative,  heteropathic,  and  in  a  few  instances,  the 
homoDopathic  methods  of  practice. 

A  general  idea  prevails,  that  all  diseases  consist  in 
"  local  determinations  of  blood,"  and  that  no  two  af 
fections  of  any  consequence,  can  exist  in  different  parts 
of  the  same  organism,  at  once.  On  this  account  it  is, 
that  new  diseases  are  created  in  healthy  parts,  for  the 
purpose  of  removing  the  primary  natural  one. 


ALLOPATHY.  69 

Physicians  have  been  led  to  adopt  this  mode  of  rea 
soning  from  observing  that  the  spontaneous  appear 
ance  of  cutaneous  eruptions,  discharges  of  blood,  pro 
fuse  perspirations,  &c.,  occasionally  afford  relief  to 
morbidly  affected  internal  organs.  Without  reflect 
ing  that  these  results  are  merely  symptoms  of  the  in 
ternal  disorders,  and  that  the  causes  upon  which  these 
signs  depend  are  located  in  the  blood,  they  attempt  to 
annihilate  diseases,  by  imitating  artificially  these  symp 
toms. 

In  regard  to  the  first  position,  we  affirm  that  their 
premises  are  untrue.  There  are  no  facts  which  war 
rant  the  statement,  that  "no  two  excessive  determi 
nations  of  blood  can  exist  in  the  same  individual  at 
the  same  time."  Neither  is  it  true,  that  the  appear 
ance  of  cutaneous  eruptions,  spontaneous  sweats, 
diarrhoea,  and  discharges  of  blood,  are  invariably, 
or  even  generally,  indications  that  the  affected  organ 
is  in  process  of  restoration,  or  that  the  system  at  large 
is  recovering  its  lost  energy  and  vigour  ;  since  it  often 
occurs  that  the  symptoms  of  the  complaint  are  all  ag 
gravated,  upon  the  supervention  of  either  of  the  above 
occurrences. 

Dr.  Wilson  observes,  that  "  there  is  often  a  remark 
able  tendency  to  the  worst  species  of  haemorrhages 
from  the  bowels,  towards  the  termination  of  fatal  cases 
of  phrenitis." 

Dr.  Eberle,  in  his  Practice  of  Physic,  remarks,  "  On 
the  day  preceding  the  fatal  termination  of  a  case  of 
phrenitis  which  came  under  my  own  observation,  an 
exceedingly  copious  discharge  of  dissolved  blood  took 
place  from  the  bowels,  and  on  the  following  morning 
the  haemorrhage  occurred  also  from  the  mouth  and 
gums." 

Let  us  suppose  a  case  of  phrenitis.  We  have  here, 
an  inflammation,  or  a  congested  state  of  the  capilla 
ries  of  the  brain.  To  relieve  this  inflammation,  and 
withdraw  a  portion  of  the  fluid  which  is  concerned  in 
the  congestion,  blood-letting,  both  general  and  local, 
is  resorted  to  as  a  primary  and  indispensable  process 
of  cure.  By  this  means,  the  general  strength  is  re 
duced,  the  pulse  increased  or  diminished  in  frequency, 
and  the  temperature  of  the  skin  altered,  but  the  con- 


70  ALLOPATHY. 

gestion  still  continues,  and  the  morbid  and  debilitated 
state  of  the  extreme  vessels  (in  which  the  disorder 
alone  resides)  remains  the  same  as  before. 

A  resort  .is  then  made  to  revulsives  and  counter-irri 
tants,  in  order  that  new  inflammations  may  be  crea 
ted  in  healthy  structures,  which  shall  supersede  that 
already  existing  in  the  brain.  To  effect  this  object, 
purgatives  of  the  drastic  kind  are  exhibited,  and  blis 
ters  applied  to  the  head,  neck,  and  lower  extremities, 
in  order  that  the  intestinal  canal,  and  portions  of  the 
skin,  shall  be  placed  in  a  state  of  artificial  inflamma 
tion. 

Let  us  understand  the  case  clearly.  We  have  a 
disease  consisting  solely  in  a  loss  of  tone  and  irrita 
bility  of  the  serous  vessels  of  the  brain,  which  prevents 
them  from  excluding  the  red  blood,  and  of  performing 
properly  their  functions.  To  obviate  this  condition,  a 
quantity  of  blood  is  abstracted,  and  artificial  or  me 
dicinal  inflammations  are  caused  in  the  intestinal 
canal,  and  upon  different  parts  of  the  surface  of  the 
body. 

We  now  inquire  in  what  manner  these  violent 
means  can,  by  any  possibility,  reach  the  seat  of  the 
malady,  and  impart  tone  and  vigour  to  the  weakened 
capillaries,  so  as  to  enable  them  to  exclude  from  their 
structure  the  red  globules,  and  resume  their  healthy 
function  ? 

All  will  concede  that  inflammation  consists  in  loss 
of  tone  and  irritability  in  these  vessels,  and  that  no 
cure  can  take  place,  until  this  impaired  irritability  is 
restored.  In  inflammation,  according  to  Philip,  Hast 
ings,  Eberle,  Wilson,  and  Allan,  the  capillaries  of  the 
part  are  in  a  state  of  debility,  and  passive  relaxation. 
The  immediate  exciting  cause  of  inflammation  may 
be  either  stimulant  or  sedative.  In  both  instances  the 
impression  is  made  upon  the  nervous  filaments  of  the 
capillaries,  and  if  the  cause  acts  as  a  stimulant,  the 
reaction  which  must  follow  this  augmented  action, 
will  leave  these  delicate  nerves  in  a  state  of  debility 
proportionate  to  the  amount  of  the  previous  excite 
ment. 

If  the  primary  cause  is  directly  sedative,  no  reaction 
will  occur,  but  a  similar  state  of  relaxation  will  obtain 
as  in  .the  former  instance. 


ALLOPATHY.  71 

How,  then,  we  repeat,  can  venesection,  cathartics 
and  blisters  affect  the  necessary  object  ?  They  do  not 
certainly  prevent  the  red  blood  from  still  entering  the 
relaxed  capillary  tubes,  for  the  whole  remaining  mass 
must  continue  to  circulate  through  the  brain,  as  well 
as  other  parts  of  the  organism,  every  few  minutes. 

By  lessening  the  quantity  of  blood,  we  also  abstract 
a  portion  of  that  natural  stimulus  of  the  organism, 
which  is  one  of  the  essential  conditions  of  irritability. 
"  Every  part  of  the  organism  depends,  for  the  perform 
ance  of  its  proper  functions,  on  the  receipt  of  arterial 
blood  and  of  nervous  influence  ;  so  alterations  in  the  sup 
ply  of  either  of  these  essentials,  may  modify  or  even  sus 
pend  the  functions  of  a  part"* 

How  absurd  and  pernicious  then,  in  inflammations, 
the  very  essence  of  which  is  debility  and  loss  of  tone, 
to  detract  from  one  of  those  conditions  upon  which 
this  very  tone  and  vigour  depends  !  As  well  might  you 
remedy  the  breach  through  which  the  waters  of  a 
raging  torrent  are  madly  rushing,  by  turning  off  from 
its  course  a  small  quantity  of  this  element.  As  well 
attempt  to  suppress  the  leak  of  a  storm-tossed  vessel, 
by  diverting  a  portion  of  the  stream  on  which  she 
floats,  from  its  natural  channel. 

It  is  not  the  blood  which  is  at  fault ;  but  a  portion 
of  the  organism.  Correct  therefore  the  cause  of  the 
disturbance  by  direct  and  appropriate  specifics,  and 
you  may  then,  and  not  until  then,  effect  cures',  safely 
and  philosophically.  Seek  not  to  deprive  the  system 
of  that  fluid  which  is  so  essential  to  the  organism,  and 
on  whose  integrity  its  functions  depend  ;  for  by  so  do 
ing,  the  cause  of  the  malady  will  remain  untouched. 

It  is  very  true,  that  when  a  large  quantity  of  blood 
is  abstracted,  during  inflammation,  there  will  seem  to 
be  in  some  instances  an  apparent  amelioration  of  all 
the  symptoms,  but  this  effect  is  only  temporary  ;  for 
as  soon  as  reaction  comes  on,  the  enfeebled  capillaries 
again  admit  the  destructive  **  carriers  of  oxygen"  as 
before ;  the  state  of  congestion  and  inflammation  re 
mains,  while  the  system  at  large  has  lost  a  portion  of 
that  stimulus  which  conduces  so  materially,  not  only 

*  Pereira's  Mat.  Med. 


ALLOPATHY. 

to  sustain  the  normal  integrity  of  the  functions  in 
health,  but  to  aid  in  the  restoration  of  enfeebled  and 
diseased  parts.  • 

The  remedies  which  stand  next  in  importance  in  the 
old  school  method  of  treating  phrenitis,  are  revulsives 
and  counter-irritants.  It  is  supposed  that  by  exciting 
the  intestinal  exhalents,  inflaming  the  membrane  of 
the  bowels,  and  portions  of  the  skin,  the  circulation  is 
diverted  from  the  brain  and  directed  especially  to 
these  parts. 

But  by  this  means  is  the  brain  in  reality  relieved  ? 
Is  the  whole  mass  of  blood  thus  prevented  from  circu 
lating  as  usual  through  this  organ  once  in  three  or 
four  minutes,  or  the  character  of  its  red  globules 
changed  ?  By  exhausting  the  energies  and  resisting 
force  of  distant  healthy  structures,  and  creating  sympa 
thetic  symptoms  throughout  the  body — thus  complica 
ting  the  already  existing  disease,  and  impairing  the  en 
tire  nervous  and  muscular  energies — are  the  inflamed 
capillaries  of  the  brain  placed  in  a  more  favourable 
condition  to  recover  their  impaired  tone  and  irrita.- 
bility  ?  Every  man  who  has  a  correct  idea  of  the 
laws  which  govern  the  organism  in  health  and  disease, 
and  who  is  willing  to  banish  prejudice  and  be  guided 
by  common  sense  and  true  philosophy,  must  answer 
in  the  negative. 

We  object  to  these  remedies,  however,  not  only  be 
cause  they  are  incompetent  to  produce  salutary  im 
pressions  upon  inflamed  parts,  but  because  of  the 
evils  of  a  positive  character  to  which  they  give  rise. 

The  chief  remedies  of  the  old  school,  are  the  pre 
parations  of  mercury,  opium,  antimony,  and  bark.  In 
a  vast  majority  of  all  the  cases  treated  by  the  prac 
titioners  of  this  school,  one  or  more  of  these  articles  is 
made  use  of.  Indeed,  scarcely  a  single  malady  of  any 
moment  can  be  named,  in  which  one  of  these  medi 
cines  is  not  considered  indispensable. 

Let  us  then  examine  some  of  their  effects,  in  allopa 
thic  doses,  upon  the  healthy  and  diseased  organism. 

1.    MERCURY. 

This  mineral  is  more -uncertain  in  its  action,  in  all 
states  of  the  system,  than  nny  other  article  in  use.  It 


ALLOPATHY.  73 

possesses  the  power  in  different  constitutions,  and  un 
der  certain  circumstances,  of  affecting  nearly  every 
organ  and  tissue  of  the  body  ;  and  it  is  not  in  the 
power  of  the  most  judicious  physician  to  say  before 
hand,  where  or  in  what  manner,  it  will  exert  its  force. 
Some  of  the  more  common  deleterious  effects  of  the 
use  of  mercury,  are,  excessive  salivation,  ulccrativn, 
gangrene  and  sloughing  of  the  gums,  mouth,  and  throat, 
gastro-enteritis,  mercurial  erethism,  dysentery,  cutaneous 
eruptions,  inflammation  of  the  periosteum  and  bones, 
nodes,  excessive  derangement  of  the  nervous  system,  pa 
ralysis,  tremors,  necroses  of  the  maxillary  and  other  bones, 
rheumatism  and  opthalmia. 

When  mercury  is  administered,  even  in  a  moderate 
quantity,  no  human  being  can  be  at  all  certain  that 
one  or  more  of  these  evil  consequences  will  not  result. 
Indeed,  it  is  the  direct  object,  oftentimes,  to  produce 
some  of  them,  to  operate  as  counter-irritants. 

Whether  it  is  employed  in  large  or  small  quantities, 
solid,  or  in  the  form  of  vapour,  is  of  little  importance, 
so  far  as  its  power  of  affecting:  the  system  is  concerned. 
The  following,  from  the  Ed.  Med.  and  Surg.  Journal, 
illustrates  the  baneful  influence  of  the  vapour  when  in 
haled  :  "  In  1810,  the  Triumph  man-of-war,  and  Phipps 
schooner,  received  on  board  several  tons  of  quicksilver, 
saved  from  the  wreck  of  a  vessel  near  Cadiz.  In  con 
sequence  of  the  rotting  of  the  bags  the  mercury  es 
caped,  and  the  whole  of  the  crews  became  more  or  less 
affected.  In  the  space  of  three  weeks  200  men  were 
salivated,  tivo  died,  and  all  the  animals,  cats,  dogs, 
sheep,  fowls,  a  canary  bird, — nay,  even  the  rats,  mice 
and  cockroaches,  were  destroyed." 

The  following  cases  resulting  from  the  employment 
of  calomel,  have  come  under  my  own  observation,  viz., 
three  cases  of  necrosis  of  the  inferior  maxillary  bones, 
requiring  the  removal  of  portions  of  the  jaw  ;  several 
cases  of  gangrene  and  sloughing  of  the  mouth  and 
throat,  which  have  terminated  fatally  ;  a  number  of 
cases  of  mercurial  palsy;  numerous  instances  oful- 
ceration  of  the  nose,  throat,  &c. ;  skin  diseases,  affec 
tions  of  the  bones,  nodes, rheumatic  affections,  &c.,  &c. 
Professor  Chapman,  after  descanting  upon  the  wo- 
ful  cffepts  which  have  so  often  been  produced  by  cal- 
4 


74  ALLOPATHY. 

omel,  and  referring  to  many  disgusting  cases  of  mer 
curial  disease  which  have  come  under  his  own  obser 
vation,  thus  concludes :  "  Who  is  it  thai,  can  stop  the 
career  of  mercury,  at  will,  after  it  has  taken  the  reins 
in  its  own  destructive  and  ungovernable  hands  ?  He 
who,  for  an  ordinary  cause,  resigns  the  fate  of  his  pa 
tient  to  mercury,  is  a  vile  enemy  to  the  sick  ;  and  if 
he  is  tolerably  popular,  will,  in  one  successful  season, 
have  paved  the  way  for  the  business  of  life  ;  for  he 
has  enough  to  do  ever  afterwards  to  stop  the  mercurial 
breach  of  the  constitutions  of  his  dilapidated  patients. 
He  has  thrown  himself  in  fearful  proximity  to  death, 
and  has  now  to  fight  him  at.  arm's  length  as  long  as 
the  patient  maintains  a  miserable  existence." 

And  this  dreadful  poison  is  the  most  common, — yes, 
the  daily  remedy  of  allopathy,  for  almost  every  dis 
order,  whether  mild  or  severe,  acute  or  chronic.  This 
is  the  agent  with  which  artificial  diseases  are  created 
in  healthy  parts,  to  cure  primary  or  natural  ones  ! 
This  is  the  substance  with  which  unfortunate  mortals 
are  drugged,  from  the  time  they  come  into  the  world, 
until  their  wretched  and  too  often  premature  depart 
ure,  with  its  well-known  and  generally  admitted  evils 
and  dangers. — -from  the  contemplation  of  which  the 
well-instructed  and  experienced  allopath  shrinks  with 
instinctive  dread, — .and  its  questionable  value  in  most 
instances  of  its  prescription,  it  may  justly  detain  our 
attention.  Calomel  and  opium  are  the  common  re 
medies  in  the  traditional  practice.  We  shall  see  to 
what  degree  they  may  be  used  in  a  practice  that  is 
philosophical. 

By  glancing  at  the  standard  works  on  the  practice 
of  medicine,  it  will  be  observed  that  there  is  scarcely 
a  single  malady,  either  acute* or  chronic,  in  which  one 
or  both  of  these  articles  is  not  recommended  as  an  im 
portant  if  not  indispensable  means  of  cure.  Taking 
Eberle's  Practice  of  Medicine  —  an  approved  allo 
pathic  work — as  a  fair  illustration  of  their  views  and 
practice,  it  will  be  seen  that  of  the  one  hundred  and 
thirty-nine  diseases,  upon  which  these  two  volumes 
treat,  there  are  only  ten,  in  which  calomel  or  opium  in 
some  form  is  not  recommended.  The  following  are 
the  nanus  of  these  exempt  diseases,  viz  :  mumps, 
ring- worm,  nettle-rash,  scurvy,  chronic  cystitis,  hysteri- 


ALLOPATHY.  75 

tis,  asphyxia,  roseola,  haematemesis,  and  nose-bleeding. 
Nor  are  these  remedies  advised  simply  as  auxiliaries 
in  the  treatment,  but  in  a  large  majority  of  cases,  they 
constitute  the  principal  means  of  cure. 

The  allopath  is  taught  to  believe  that  mercury  ex 
cites  the  functions  of  all  the  organs — acts  specifically 
upon  the  liver,  salivary  glands,  heart,  lungs,  and  ner 
vous  system — and  therefore  that  it  may  be  administered 
almost  universally.  Regardless  of  the  secondary  sym 
pathetic  affections  to  which  it  usually  gives  rise,  he 
attributes  all  of  these  symptoms  to  the  natural  disor 
der,  and  if  the  patient  succumbs  before  the  combined 
attacks  of  the  primary  disease  and  the  medicinal  one, 
he  consoles  himself  with  the  reflection  that  he  has  fol 
lowed  his  authorities  and  prescribed  as  his  predecessors 
have  done  for  centuries  before  him. 

Ask  him  what  are  his  views  concerning  inflamma 
tion,  and  he  answers  that  it  consists  in  a  debilitated 
and  congested  state  of  the  capillaries  of  the  part  affect 
ed.  Ask  him  what  is  the  modus  medendi  of  mercury 
in  the  cure  of  inflammation, — how  any  of  its  effects 
can  reach  the  seat  of  the  malady,  the  congested  ca 
pillaries,  and  restore  to  them  their  impaired  tone  and 
healthy  functions, — and  he  either  avows  his  ignorance 
or  offers  an  unsatisfactory  explanation. 

2.    OPIUM. 

If  we  except  calomel,  this  drug  and  its  preparations 
are  more  frequently  used,  by  the  medical  men  of  the 
old  school,  than  any  other  article  in  the  Materia  Medi- 
ca.  Possessing  the  power,  as  it  does  in  an  eminent 
degree,  when  exhibited  in  large  doses,  of  covering 
(not  curing)  symptoms,  and  of  shutting  the  mouths 
of  clamorous  and  inquiring  patients,  it  is  used  con 
stantly  and  indiscriminately  in  nearly  all  protracted 
maladies. 

Let  us  then  briefly  examine  ihe  effects  of  opium  in 
health  and  disease,  and  see  if  irfpossesses  the  wonder 
ful  property  of  reaching  every  structure,  and  of  coun 
teracting  so  many  diverse  and  contradictory  symp 
toms. 

Its  effects  upon  the  human  system,  in  medium  doses, 
are  in  the  first  instance  stimulating,  succeeded  in  a 
short  time  by  diminished  sensibility  and  desire  to  sleep. 


76  ALLOPATHY. 

"This  continues  from  eight  to  twelve  hours,  and  is 
followed  by  nausea,  headache,  tremors,  and  other 
symptoms  of  diminished  and  irregular  nervous  energy. 
All  of  the  secretions,  with  the  exception  of  that  from  the 
skin,  are  either  suspended  or  diminished"*  These  ef 
fects,  with  a  very  few  exceptions,  are  uniform  under 
all  circumstances,  so  far  as  we  can  judge. 

How,  then,  is  this  substance  applicable  to  the 
treatment  of  so  many  diseases  ? 

We  have  remarked  that  in  all  maladies,  there  exists 
an  inflammation  of  an  acute  or  sub-acute  character, 
in  some  part  of  the  organism,  and  it  is  the  presence  of 
this  inflammation  which  maintains  and  perpetuates 
them. 

We  have  also  observed  that  all  inflammations  con 
sist  in  a  congested  state  of  the  capillaries  of  the  part 
affected,  caused  and  kept  up  by  a  loss  of  tone,  resist 
ing  power,  or  irritability,  which  disables  them  from 
resisting  the  intromission  of  red  blood. 

It  is  apparent,  then,  that  in  order  to  prove  efficient, 
such  remedies  should  be  exhibited  as  are  capable  of 
acting  upon  the  seat  of  the  complaint,  and  of  restor 
ing  the  delicate  capillary  nerves  to  their  normal  state 
of  integrity.  Opium  cannot  accomplish  this,  for  its 
operation  tends  to  impair  the  nervous  energy,  instead 
of  adding  vigour,  to  dry  up  most  of  the  secretions,  in 
stead  of  aiding  nature  to  give  vent  to  the  poisonous  and 
pent  up  fluids,  it  induces  nausea,  headache,  tremors, 
and  many  other  medicinal  symptoms  of  sufficient  se 
verity  to  make  a  healthy  man  sick,  or  to  complicate 
to  a  serious  extent  any  existing  natural  affection. 

If  it  be  urged  that  opiates  have  the  power  of  allay 
ing  pain,  while  other  more  efficient  measures  are 
pursued  to  effect  the  cures,  we  reply,  that  by  covering 
up  the  pain,  the  real  state  of  the  case  is  concealed  ; 
other  new  symptoms  set  in,  which  will  be  unnoticed 
by  the  benumbed  patient,  while  secondary  sympa 
thetic  affections  will  be  propagated  to  every  part  of 
the  body,  aggravating  and  complicating  the  original 
disorder. 

Opium  is  also  highly  extolled  in  low  forms  of  fever, 

*  Wood  and  Bacho,  U.  S.  Diapen. 


ALLOPATHY.  77 

and  other  complaints,  where  the  powers  of  the  system 
are  in  an  exhausted  condition.  But  let  it  be  remem 
bered,  that  the  stimulating  effect  of  this  drug  is  of  short 
duration,  and  that  the  corresponding  reaction  or  de 
pression  will  bear  an  exact  ratio  to  the  previous  ex 
altation.  This  law  is  fundamental  ;  for  the  system 
possesses  but  a  definite  and  limited  amount  of  vital 
power,  and  is  capable  of  resisting  only  a  limited  de 
gree  of  unnatural  action  or  disease,  so  that  we  can 
readily  perceive  how  opiates,  and  other  stimulants, 
must  ultimately  prove  deleterious. 

It  is  true  that  perspiration  is  promoted  by  the  use  of 
this  narcotic,  but  this  does  not  cure.  Sweating  is 
merely  a  symptom,  and  it  may  be  favourable  or  other 
wise.  When  excited  artificially  by  medicine,  it  is  not 
productive  of  benefit,  because  this  adds  nothing  to 
wards  invigorating  the  weakened  capillaries. 

"  Perspiration  induced  by  medicine  is  of  little  mo 
ment,  unless  the  remedy  simultaneously  impresses, 
directly  or  indirectly,  the  parts  diseased',  and  then  the 
salutary  results,  so  far  as  the  surface  is  concerned, 
depend  upon  special  vital  influences  exerted  by  the 
remedy  upon  the  skin  and  reacting  sympathies.  This 
is  exemplified  by  the  profound  effects  of  tartarized 
antimony  and  ipecacuanha,  the  uselessness  of  hot 
\vater,  and  the  frequent  pernicious  results  of  the  com 
pound  powder  of  ipecacuanha,  when  free  perspiration 
may  follow  the  administration  of  either.  The  effect, 
therefore,  depends  but  very  little  upon  the  evacuation 
from  the  skin,  as  produced  by  what  are  called  su- 
dorifics."* 

It  is  proper  to  observe  that  opium  may,  and  some 
times  does,  effect  cures  in  the  hands  of  allopathists, 
when  given  as  a  specific.  Its  curative  virtues  in  ma 
nia  a  potu  and  intoxication,  even  in  large  doses,  are 
well  known.  In  these  instances,  the  remedy  impresses 
directly  the  part  diseased,  and  cures  homos  op  at  Ideally. 
It  is  quite  true  that  an  infinitesimal  quantity  of  the 
drug,  properly  prepared,  will  always  prove  more  effi 
cient,  speedy,  and  safe,  in  accomplishing  the  object, 
and  will  not  give  rise  to  the  unpleasant  medicinal 

*  Paino's  Inst.  of  Med. 


78  ALLOPATHY. 

symptoms  which  necessarily  attend  the  employment 
of  large  doses ;  yet  the  fact  must  be  conceded,  that 
clumsy  and  unscientific  cures  are  occasionally  effected 
by  the  course  alluded  to. 

An  interesting  case  is  related  by  Pereira,  illustra 
tive  of  this.  "  Opium  is  sometimes  employed  by 
drunkards  to  relieve  intoxication.  I  knew  a  medical 
man  addicted  to  drinking,  and  who  for  many  years 
was  accustomed  to  take  a  large  dose  of  laudanum 
whenever  he  was  intoxicated,  and  was  called  to  see  a 
patient."  The  specific  effects  of  the  alcoholic  stimu 
lants  and  opium,  given  during  health,  are  exerted  as 
remarked  at  page  43,  upon  the  same  organ  ;  and  we 
should  therefore  expect  that  a  malady  caused  by  the 
excessive  use  of  the  one,  might  be  cured  by  the  specific 
action  of  the  other. 

TARTARIZED    ANTIMONY. 

This  salt  has  been  several  times  formally  banished 
from  the  Materia  Medica,  on  account  of  its  dangerous 
qualities,  and  as  often  revived  again. 

The  Faculty  of  Medicine,  at  Paris,  in  1566  and 
1615,  passed  solemn  decrees  against  it,  as  a  virulent 
poison,  and  these  decrees  were  even  sanctioned  by 
parliament,  though  afterwards  formally  reversed.* 

Since  this  period,  some  have  loudly  extolled  its  vir 
tues  in  the  treatment  of  a  great  variety  of  diseases, 
while  others  have  as  earnestly  condemned  its  use,  as 
deleterious  in  all  cases. 

The  celebrated  Professor  Nathan  Smith,  in  his 
Essay  on  Typhus  Fever,  remarks,  "  I  have  seen  many 
cases  in  which  persons  in  the  early  stages  of  this 
disease  were  moping  about,  not  very  sick,  but  far 
from  being  well,  and  who,  upon  taking  a  dose  of  tar- 
tarate  of  antimony,  with  the  intention  of  breaking  up 
the  disease,  have  been  immediately  confined  to  their  beds." 
He  arrives  at  the  conclusion,  after  much  experience, 
that  "  tartar  emetic  should  not  be  used  in  this  affec 
tion,  even  at  its  commencement  ;  and  in  the  latter 
stages  of  the  disease,  that  it  is  sometimes  followed  by 
fatal  consequences." 

*  Vale. 


ALLOPATHY.  79 

Iii  emetic  doses,  tartarized  antimony  irritates  the 
stomach,  causes  congestion,  and  sometimes  inflamma 
tion  of  the  lungs,  attended  with  more  or  less  constitu 
tional  disturbance.  When  it  fails  to  produce  emesis 
speedily,  it  often  acts  violently  upon  the  bowels,  giv 
ing  rise  to  severe  griping  pains  and  watery  evacua 
tions.  The  tenderness  of  the  stomach  and  intestines, 
and  the  constitutional  disturbance  which  succeeds  its 
emetic  and  cathartic  operation,  indicates  the  injury 
which  these  delicate  structures  have  sustained. 

The  primary  impression  of  antimony  is  not  the  only 
objection  against  its  employment  ;  for,  like  calomel 
and  opium,  it  gives  rise  to  numerous  secondary  symp 
toms  in  remote  parts,  which  tend  to  aggravate  in  a 
serious  manner  any  natural  affection  which  may  be 
present.  One  of  the  most  important  of  these  secondary 
evils,  is  dilatation  of  the  ventricles  of  the  heart.  Hav 
ing  witnessed  this  result  in  several  instances,  one  of 
which  occurred  in  my  own  family,  my  attention  has 
been  particularly  directed  to  the  subject,  and  I  am 
fully  of  opinion  that  cases  of  this  description,  from  the 
use  of  antimony,  are  by  no  means  unfrequent. 


CINCHONA. 

In  intermittent  fevers,  general  debility,  and  in  cer 
tain  stages  of  most  other  affections,  Peruvian  bark  and 
its  preparations  are  usually  employed  by  the  old 
school.  For  the  cure  of  the  former,  especially,  quinine 
is  the  remedy  upon  which  universal  reliance  is  placed ; 
possessing  the  property,  when  used  in  large  and  re 
peated  doses,  of  speedily  arresting  the  chills  and  fever, 
it  is  constantly  prescribed  for  this  malady,  without 
the  slightest  knowledge  of  its  processes,  and  without 
any  regard  to  the  dangerous  medicinal  disorders  which 
it  superinduces. 

All  allopathists  who  have  had  much  experience  in 
the  treatment  of  fever  and  ague,  are  aware  that  the 
mere  suppression  of  the  paroxysms  by  no  means  re 
stores  the  patient  to  health  ;  for  in  a  great  majority 
of  instances,  he  lingers  for  months  or  even  years  in  a 
diseased  and  miserable  condition.  In  the?e  cases  it  is 


80  ALLOPATHY. 

probable  that  a  medicinal  affection  is  induced  by  the 
remedy,  so  serious  in  its  character,  as  to  supersede 
temporarily  the  primary  one.  This  is  evident,  from 
the  fact  that  after  the  effects  of  the  medicine  have 
somewhat  subsided,  the  original  disorder  again  gene 
rally  makes  its  appearance.  In  some  instances,  how 
ever,  the  medicinal  affection  is  so  severe  as  to  consti 
tute  a  permanent  disease,  and  thus  entirely  usurp  the 
place  of  the  fever. 

"  Experience  shows  that,  though  bark,  and  its  alka 
loids,  in  large  doses,  will  often  arrest  intermittent  fe 
ver  suddenly,  such  doses  are  liable  either  to  induce 
some  congestion,  especially  of  the  liver  or  of  the  mu 
cous  tissue  of  the  stomach,  or  will  aggravate  and  es 
tablish  some  co-existing  congestion ;  and  thus  while 
the  patient  is  for  the  present  relieved  of  the  fever,  he 
is  dismissed  with  an  insidious  local  complaint  that  not 
only  renders  him  a  permanent  invalid,  (resulting  often 
in  indurated  enlargements,)  but  which  local  malady  may, 
and  often  does  become,  in  process  of  time,  the  exciting 
cause  of  another  attack  of  fever.  In  respect  to  relapses, 
it  is  nor,  unfrequent  that,  when  intermittents  are  sud 
denly  stopped  by  a  large  dose  of  quinine,  the  parox 
ysms  return  as  soon  as  the  patient  begins  to  exercise 
much,  or  to  take  his  ordinary  food."* 

We  should  naturally  suppose  that  these  untoward 
results  would  deter  practitioners  from  using  so  fre 
quently  these  dangerous  remedies ;  or  at  all  events, 
as  rarely  and  in  as  small  quantities  as  possible. 

On  the  contrary,  it  seems  to  be  peculiar  to  allopathy, 
that  her  advocates  take  credit  to  themselves,  when 
they  succeed  in  administering  this,  as  well  as  other 
medicines,  in  larger  doses  than  any  of  their  contempora 
ries,  without  destroying  their  patients.  Indeed,  so  far 
has  this  destructive  system  been  carried,  of  experi 
menting  upon  disease,  that  the  enormous  quantity  of  a 
scruple  and  even  half  a  dram  of  quinine  has  been  ex 
hibited  at  a  dose,  and  repeated  several  times  a  day. 
These  monstrous  quantities  create  f  gastro-enteritic 
irritation,  nausea,  griping,  purging,  head-ache,  giddi- 

*  Paine's  Inst,  of  Medicine.  I  Wood  and  Bache. 


ALLOPATH Y.  81 

ness,  fever,  somnolency,  in  some  cases  delirium,  in 
others  stupor,"  &c.  Paine  asserts  that  he  has  wit 
nessed  many  of  these  effects  "  from  five  grains  only  ;" 
yet,  as  patients  sometimes  live  in  spite  of  this  treat 
ment,  many  persist  in  adopting  these  desperate  inno 
vations. 

There  are  many  other  medicines  employed  by  allo 
pathy  in  the  treatment  of  disease,  besides  those  to 
which  we  have  alluded,  but  in  general  they  serve  on 
ly  as  auxiliaries.  In  this  list  may  be  ranked  diapho 
retics,  diuretics,  expectorants,  refrigerants,  emmena- 
gogues,  emollients,  errhines,  &c.,  but  the  articles  be 
longing  to  each  of  these  classes,  in  a  crude  state  and  in 
large  doses,  are  liable  to  important  objections. 

The  fault  of  those  medicines  which  operate  spe 
cifically,  like  diuretics,  emmenagogues,  &c.,  in  the 
hands  of  allopathists,  is  the  aggravation  which  they 
must  necessarily  cause,  if  the  part  acted  upon  be  irri 
tated  or  inflamed.  This  objection  will.be  clearly  ap 
preciated,  when  it  is  remembered  how  extremely  sen 
sitive  to  specific  remedial  impressions,  organs  and  tis 
sues  become  during  inflammation. 

The  evils  resulting  from  the  use  of  those  medicines 
which  are  not  specifics,  are,  first,  their  inability  to 
reach  the  seat  of  the  complaint,  and  secondly,  the 
sympathetic  derangements  to  which  they  give  rise  in 
various  parts  of  the  body,  the  direct  tendency  of 
which,  is  to  retard  and  counteract  the  recuperative  ef 
forts  of  nature. 

As  an  example  of  the  first  class,  let  us  take  the  di 
uretic  copaibae,  as  a  remedy  for  gonorrhoea.  In  this 
example,  the  remedy  doubtless  impresses  directly  the 
inflamed  membrane  of  the  urethra,  but  the  impression 
is  so  violent  that  either  a  decided  increase  of  the  in 
flammation  ensues,  or  the  discharge  is  suddenly  sup 
pressed,  and  some  other  organ,  as  the  bladder,  kidneys, 
testicles,  or  lungs,  takes  on  diseased  action.  Indeed  we 
are  decidedly  of  opinion,  that  not  one  genuine  case  of 
virulent  gonorrhoea  can  be  adduced  where  a  safe  and 
permanent  cure  has  been  effected  by  large  doses  of 
this  balsam. 

A  not  unfrequent  effect  of  copiaboe  in  moderate  quan- 


82  ALLOPATHY. 

titles,  is  to  excite  serious  disorder  of  the  lungs.  This 
consequence  I  have  often  witnessed,  and  I  have  a  pa 
tient  at  this  time,  who  assures  me  that  he  is  unable  to 
take  a  single  dose  of  it,  without  being  afflicted  with  a 
pain  in  his  chest,  and  cough. 

Gastric  and  intestinal  disturbance,  also,  usually  re 
sult  from  its  use.  In  some  instances,  a  troublesome 
eruption  makes  its  appearance,  rendering  it  necessary 
to  discontinue  its  employment  for  a  time.  And  yet 
with  all  of  these  artificial  consequences,  the  disease  is 
very  rarely,  if  ever,  cured  by  this  nauseous  substance. 

Diaphoretics  were  introduced  into  practice  by  the 
advocates  of  the  humoral  pathology,  under  the  sup 
position  that  their  sweating  qualities  would  aid  nature 
in  throwing  off  the  morbid  humours.  When  the  hy 
pothesis  universally  obtained  that  fevers  were  caused 
by  an  excess  of  one  of  the  four  humours,  blood,  phlegm, 
and  yellow  and  black  bile,  and  that  this  superabund 
ance  must  be  expelled  through  the  pores  of  the  skin, 
kidneys,  &c.,  it  was  a  rational  deduction  that  the  em 
ployment  of  diaphoretics  and  diuretics  should  conduce 
essentially  to  aid  nature  in  the  cure. 

But  when  more  correct  ideas  in  regard  to  the  nature 
and  seat  of  diseases  were  introduced,  and  medical  men 
had  learned  that  spontaneous  sweating,  diuresis,  dis 
charges  of  blood,  diarrhoea,  &c.,  in  the  latter  stages  of 
diseases,  occurred  in  consequence  of  a  natural  amend 
ment  or  a  sudden  prostration  in  the  powers  of  the  af 
fected  parts,  and  not  as  an  effect  of  the  medicines,  it  is 
a  matter  of  surprise  that  these  uncertain  remedies 
should  have  been  retained. 

The  late  Professor  Nathan  Smith,  makes  use  of  the 
following  language,  replete  with  good  sense  :  "  As 
there  is  more  or  less  sweating  in  the  decline  of  most 
febrile  diseases,  and  as  a  general  perspiration  is  often 
accompanied  with  other  symptoms  of  amendment,  it 
has  been  looked  upon  as  the  natural  cure  of  the  disease. 
Under  this  impression,  it  has  been  a  pretty  universal 
practice  to  encourage  sweating ;  but  with  respect  to 
the  grounds  upon  which  this  practice  is  founded,  it  is 
a  question  whether  the  effect  has  not,  in  this  case,  been 
mistaken  for  the  cause  ;  that  is,  whether  the  sweating 
is  not  the  effect  of  the  amendment,  rather  than  the 


ALLOPATHY.  83 

cause  of  it ;  and  if  so,  it  is  still  more  questionable, 
whether  sweating,  produced  by  art  in  the  beginning 
of  the  disease,  would  be  attended  with  good  effects. 
In  all  cases,  where  I  have  seen  this  sweating  regimen 
adopted.,  the  practice  has  been  obviously  injurious" 

Many  other  eminent  professors,  as  may  be  readily 
proved,  entertain  similar  views  in  regard  to  this 
subject. 

Physiology  teaches  us  that  no  unusual  disturbance, 
no  inflammation,  and  no  functional  derangement,  can 
accrue  to  any  part  of  the  body,  whether  by  a  moral, 
physical,  morbific,  or  medicinal  agent,  without  being 
followed  by  secondary  sympathetic  symptoms  in  re 
mote  parts,  more  or  less  severe  according  to  the  vio 
lence  of  the  exciting  cause.  The  stomach  and  bowels, 
more  especially,  being  the  grand  centre  of  junction  of 
the  ganglionic  system  of  nerves,  are  so  intimately 
connected  with  all  parts  of 'the  economy,  that  dis 
turbances  at  either  of  these  points  are  reflected 
through  the  sympathetic  nerves  upon  remote  healthy 
structures,  thus  complicating  to  a  serious  and  often 
fatal  extent,  any  disorder  which  may  already  be  pre 
sent. 

There  is  scarcely  any  part  of  the  machine  which  is 
not  called  into  morbid  sympathetic  action,  by  de 
rangements  of  the  stomach  and  intestines.  Even  the 
presence  of  bile,  or  acid,  in  unusual  quantities,  causes 
pains  in  the  head  and  limbs,  nausea,  and  other  affec 
tions  of  a  distressing  nature,  until  the  offending  sub 
stances  are  removed. 

All  of  the  organs  and  tissues  are  so  closely  con 
nected  by  the  nervous  system,  that  it  may  be  laid 
down  as  a  general  rule,  that  no  disorder  can  happen 
to  one  part  without  implicating,  more  or  less,  other 
parts,  whether  diseased  or  healthy.*  "  A  particular 
state  of  one  organ,  such  as  inflammation,  or  a  se 
creting  action  in  it,  often  causes  the  production  of  a 
similar  state  in  other  parts.  The  principle  of  the 
balance  of  sympathy  teaches  us  how  we  must  avoid 
aggravating  the  morbid  condition  of  one  organ  by  the 
means  which  we  apply  to  another" 

*  Miiller's  Physiology. 


84  ALLOPATHY. 

How  reasonable,  then,  to  expect  that  artificial  me 
dicinal  inflammations  of  the  sensitive  structures  of 
the  economy,  should  give  rise  to  secondary  affections 
of  a  grave  and  permanent  character. 

In  conclusion,  the  theoretical  and  practical  doc 
trines  of  allopathy  may  be  briefly  summed  up  as  fol 
lows  : 

1 .  In  the  rude  ages  of  the  world,  when  the  arts  and 
sciences  were   in  their  infancy, — when  vague,  indefi 
nite   and  absurd  notions  were  entertained  respecting 
diseases, — when  anatomy,  chemistry,  physiology,  pa 
thology,  botany,  and  even  correct  methods  of  induc 
tion,  were  entirely  unknown, — when  the  imaginations 
of  men,  instead  of  ascertained  facts,  were  appealed  to 
in  establishing  theories, — and  when  systems  of  practice 
were  founded  upon  merely  fanciful  conjectures ;  then 
it    was    that    blood-letting,    cathartics,   diaphoretics, 
diuretics,  refrigerants,  revulsives,  derivatives,  counter- 
irritants,  and  most  of  the  other  remedies  of  allopathy, 
made  their  first  appearance.    As  the  pathological  doc 
trines  of  this  period  were  all  entirely  erroneous,  it  is 
but  fair  to  conclude  that  their  therapeutical  inferences 
must  have  been  equally  incorrect. 

2.  Whatever  may  have  been  the  changes  in  respect 
to  the  theory  of  disease,  from  age  to  age,  long  estab 
lished  customs,  the  force  of  habit,  education,  preju 
dice,  &c.,  have  served  to  retain  until  our  own  period, 
most  of  the  violent,  unnatural  and  pernicious  methods 
of  treatment,  invented  and  adopted  by  the  founders  of 
medicine. 

3.  At   the  present  time,  everything  pertaining  to 
the  theory  and  practice  of  the  old  school  is  indefinite, 
obscure,  and  uncertain.     Scarcely  two  different  allo- 
pathists  entertain  the  same  views  in  regard  to  patho 
logy,  and  not  one  can  determine  beforehand,  with  any 
kind  of  certainty,  precisely  what  effects  his  medicine 
will  produce  ;  yet,  in  the  treatment  of  nearly  all  cases, 
venesection,  calomel,  opium  and  antimony  are  empyri- 
cally,  and,  we  might  almost  say, universally  employed. 
In  those  cases  where  refrigerants,  diuretics,  expecto 
rants,  &c.,  are  used,  they  can  only  be  looked  upon  as 
auxiliaries,  and  are  usually  administered  without  any 


ALLOPATHY.  85 

accurate  knowledge  as  to  whether  they  promote  or 
retard  the  designs  of  nature. 

4.  Owing  to  the  absence  of  any  generally  received 
or  consistent  theory  of  disease,  allopathists  are  obliged 
to  prescribe  at  random.    They  strike  at  the  name,  and 
not  at  the  seat  of  maladies,  where  alone  remedies  can 
prove  efficient.     Thus  it  is  that  patients  are  so  often 
reduced  to  the  lowest  point,  by  medicines,  while  the 
disease  continues  its  progress,  unchecked. 

5.  Lastly,  there  is  every  reason  to  believe,  that  the 
production   of  violent   artificial  diseases   in  healthy 
structures,  for  the  suppression  of  natural  maladies,  is, 
upon  the  whole,  far  more  productive  of  deleterious 
than  of  beneficial  consequences. 

In  view,  therefore,  of  the  present  condition  of  the 
medical  art,  we  most  earnestly  request  the  allopath 
to  pause,  and  reflect  deeply  and  seriously,  before  per 
sisting  in  the  use  of  venesection,  revulsives,  derivatives, 
alteratives,  and  counter-irritants.  Let  him  remember 
that  a  high  responsibility  attaches  to  his  position, — 
that  the  welfare,  happiness,  and  lives  of  his  patients 
hang  upon  his  judgment  and  decision, — and  that  an 
improper  exhibition  of  remedies  may  so  complicate 
and  aggravate  the  natural  disease,  as  to  consign  his 
patient  to  a  premature  grave.  Let  him  look  about, 
candidly  and  impartially,  and  see  if  there  are  really 
no  improvements  in  the  practice  of  the  healing  art, 
since  the  times  of  Hippocrates  and  Galen.  Let  him 
submit  new  discoveries  and  new  doctrines  to  a  rigid 
practical  test,  and  decide  from  the  results — from  the 
cures  effected — what  system  is  most  correct  and  best 
calculated  to  promote  the  welfare  of  the  human  race. 
Let  him  no  longer  reverence  ancient  doctrines  and 
ancient  names,  simply  on  account  of  their  antiquity, 
but  seek  after  truth  alone,  whether  of  ancient  or  mo 
dern  discovery,  and  found  his  practice  only  upon  this 
certain  basis. 


86 
CHAPTER    IX. 

HOMOEOPATHY. 

When  Hahnemann  first  promulgated  to  the  world 
his  pathological  and  therapeutical  views,  their  novel 
ty,  their  entire  variance  from  all  preconceived  opin 
ions,  and  their  alleged  superiority  over  all  other 
systems,  when  applied  to  the  practice  of  the  healing 
art,  induced  physicians  to  suppose  the  man  mad,  and 
his  ideas  the  offspring  of  a  disordered  imagination. 

It  was  difficult  to  conceive  that  acute  maladies 
could  be  cured  without  venesection,  emetics,  cathar 
tics,  sudorifics,  refrigerants,  alteratives,  and  counter- 
irritants,  and  on  this  account  the  great  discoveries  of 
the  father  of  homoeopathy  were  for  many  years  coldly 
received,  and  his  arguments  answered  only  by  impu 
dent  sneers,  or  senseless  ridicule. 

Like  the  illustrious  Fulton,  who — when  he  an 
nounced  to  his  countrymen  the  powers  of  steam,  and 
first  applied  this  agent  to  the  propulsion  of  a  vessel — 
was  declared,  even  by  his  nearest  friends,  insane,  and 
his  projects  visionary  ;  like  Harvey,  the  discoverer 
of  the  circulation  of  the  blood,  who  was  bitterly  at 
tacked  "  by  the  bigoted  abettors  of  old  established 
systems,  with  whispers,  inuendoes,  and  controversial 
writings,"  and  himself  pronounced  a  reckless  innova 
tor,  and  unworthy  of  public  confidence  as  a  prac 
titioner  ;  like  Galileo,  who,  after  demonstrating  the 
truth  of  the  Copernican  system,  was  persecuted  by  his 
rivals,  and  twice  compelled  by  the  inquisition  to  ab 
jure  a  system  which  he  knew  to  be  correct ;  like 
Columbus,  Newton,  Locke,  Jenner,  and  many  other 
benefactors  of  the  human  race,  Hahnemann  has  been 
aspersed,  and  his  doctrines,  like  theirs,  have  been  ridi 
culed,  misrepresented,  and  contemned  ;  but  time  has 
cast  all  the  calumniators  of  Columbus,  of  Galileo,  of 
Newton,  of  Locke,  of  Harvey,  of  Jenner,  of  Fulton, 
into  a  deserved  oblivion,  while  the  names  of  these 
eminent  persons  stand  high  on  the  roll  of  fame,  and 
their  discoveries  remain  to  benefit  the  world. 

The  public  of  Europe  and    America   are  fast  ren- 


HOMCEOPATHY.  87 

dering  the  same  justice  to  Hahnemaiin  and  his  doc 
trines,  and  the  time  will  ere  long  arrive,  when  the 
united  world  \vill  rank  him  by  the  side  of  those  great 
men  to  whom  we  have  just  alluded.  It  is  even  now 
conceded  by  many  eminent  allopathic  writers,  that 
the  hypothetical  doctrines  of  homceopathy  are  correct. 
By  referring  to  page  65,  it  will  be  observed  that  the 
pathological  views  of  Hahnemann,  and  some  of  the 
professors  of  the  old  school,  coincide  in  a  very  striking 
manner.  Indeed,  it  is  a  matter  of  doubt  whether  there 
can  be  found  in  the  medical  ranks,  two  more  staunch 
advocates  of  the  "  vital  theory,"  than  Samuel  Hahne 
mann,  the  homoeopathist,  and  Martyn  Paine,  the  allo- 
pathist. 

But  when  we  come  to  the  therapeutical  inferences 
deduced  from  these  opinions,  we  find  a  wide  and  es 
sential  difference.  The  latter,  in  summing  up  his 
method  of  treatment,  has  retained  all  of  the  violent 
and  barbarous  remedies  of  antiquity,  with  very  little 
knowledge  of  their  mode  of  operation  upon  the  human 
system,  and  with  as  little  certainty  as  to  whether  they 
will  ameliorate  or  aggravate  disease. 

The  former  has  pursued  a  different  course.  In  con 
sideration  of  the  facts,  that  the  action  of  no  two  medi 
cines  upon  the  economy  is  the  same, — that  almost 
every  agent  exercises  a  peculiar  and  specific  influence 
upon  certain  structures  only,  and  that  this  specific 
effect  obtains  both  in  health  and  disease,  he  instituted 
a  series  of  accurate  experiments  during  health,  in 
order  to  arrive  at  the  pure  effects  of  different  medici 
nal  substances.  The  illustrious  founder  of  homoeo 
pathy  not  only  tested  the  operation  of  medicines  upon 
his  own  person,  but  he  induced  others — men  of  science 
and  undoubted  integrity  in  different  parts  of  Europe — - 
to  make  trials  of  the  same  substances,  without  in 
forming  them  of  the  results  of  his  own  experiments  ; 
and  when  their  observations  were  completed,  he  in 
stituted  comparisons,  and  found  that  the  effects  of  the 
medicines  upon  the  different  individuals  were  almost 
uniformly  the  same.  Having  now  ascertained  with 
certainty  the  pure  effects  of  a  number  of  articles 
during  health,  he  commenced  exhibiting  them  for  the 
cure  of  diseases,  in  accordance  with  the  principle 


88  HOMOEOPATHY. 

which  he  had  conceived  to  be  philosophical  and  true, 
similia  similibus  curantur.  We  need  not  repeat,  that 
the  results  of  these  experiments  were  in  the  highest 
degree  satisfactory. 

In  the  early  part  of  his  career,  Hahnemann  made 
use  of  the  pure  mother  tinctures,  in  ordinary  doses, 
but  he  observed  that  the  primary  effects  were  too  ac 
tive, — there  usually  occurring  a  temporary  augmen 
tation  of  the  symptoms.  This  induced  him  to  reduce 
his  doses  until  he  came  to  make  use  of  attenuations 
and  dilutions  ;  and  he  found,  that  when  the  medicines 
were  properly  prepared,  they  still  had  their  specific 
action,  and  that  disease  was  more  speedily  removed 
than  when  stronger  preparations  were  employed. 

But  the  principal  objection  which  was  formerly, 
and  which  still,  to  a  considerable  extent,  is  raised 
against  the  system  of  homoeopathy,  is  the  supposed 
inefficiency  of  infinitesimal  quantities  of  medicines 
when  administered  as  curative  agents.  Nor  is  this  at 
all  surprising,  for  it  has  been  customary  for  three 
thousand  years,  when  disturbance  prevails  in  the  hu 
man  citadel,  to  storm  it  with  agents  of  destruction. 
Blood  is  made  to  flow,  the  delicate  membranes  of  the 
stomach  and  intestines  are  raked  with  broadsides  of 
emetics  and  drastics,  the  nervous  system  is  shattered 
by  narcotics  and  stimulants,  and  the  functions  of  every 
organ  deranged  by  the  showers  of  destructive  allopa 
thic  missiles  with  which  the  enfeebled  body  is  con 
stantly  assailed.  By  these  summary  means  the  dis 
turbance  is  smothered,  but  the  citadel  is  in  decay, 
its  resources  exhausted,  its  foundations  impaired,  and 
its  strength  forever  diminished. 

Homoeopathy,  however,  resorts  to  a  different  mode 
of  procedure.  In  her  remedial  measures,  she  uses  no 
unnatural  violence,  nor  seriously  disturbs  the  function 
of  any  organ ;  but  her  remedies  are  exhibited  with  a 
definite  object  ;  the  affected  organ  or  tissue  is  acted 
upon  with  almost  mathematical  certainty,  and  that 
too  without  creating  disease  in  healthy  parts,  or  in 
any  way  complicating  the  natural  affection.  But  she 
usually  administers  her  medicaments  in  infinitesimal 
doses,  and  we  now  come  to  the  question  wh ether  such 
minute  quantities  of  matter  are  capable  of  producing 


HOMOEOPATHY.  "  89 

salutary  impressions  upon  the  organism  when  labour 
ing  under  disease  ? 

No  one  will  deny  that  the  human  body  during  health 
is  constantly  being  acted  upon  and  disturbed  by  in 
fluences  or  agents  so  subtle,  that  neither  the  chemist 
nor  physiologist  can  analyze  or  even  detect  them. 
The  simple  application  of  substances  to  the  surface 
of  the  body  is  sufficient  to  produce  decided  and  per 
manent  effects.  Turnbull  says,  that  "  so  small  a  por 
tion  as  the  one  hundredth  part  of  a  grain  of  aconite, 
made  into  an  ointment,  and  rubbed  upon  the  skin,  has 
produced  a  sensation  of  heat,  pricking,  and  numbness, 
that  has  continued  a  whole  day." 

A  leaf  of  tobacco  applied  to  the  wrist  or  sole  of  the 
foot,  will  excite  the  action  of  the  respiratory  muscles, 
blood-vessels,  glands,  and  skin,  causing  nausea,  vo 
miting,  &c. 

If  the  leaves  of  hyoscyamus  or  belladonna  be  ap 
plied  to  the  eye,  an  effect  will  be  produced  which  will 
remain  for  several  weeks.  It  is  asserted  by  Pereira 
and  Sigmond,  that  "  a  dilatation  of  the  pupils  may  be 
produced  by  only  approximating  the  leaves  of  hyoscya 
mus  or  belladonna  to  the  eyes." 

It  is  also  well  known,*  that  "  violent  erysipelatous 
inflammation  over  the  whole  surface  of  the  body,  is 
often  induced  from  approaching  within  a  few  yards  of 
several  species  of  rhus." 

The  wild  buffalo  scents  the  hunter  for  a  distance 
of  more  than  a  mile,  and  hastens  from  the  vicinity  of 
danger. 

The  carnivorous  bird  recognises  the  odoriferous  par 
ticles  arising  from  a  dead  carcass,  miles  distant  in  the 
air,  and  with  hasty  wing,  pounces  upon  the  prey. 

The  medicinal  quality  of  cod  liver  oil  (ol.  jec. 
aselli)  consists  of  iodine  distributed  in  infinitesimal 
quantities  throughout  the  oil.  According  to  an  analy 
sis  made  by  Falker,  the  iodine  forms  only  the  one- 
forty-thousandth  part  of  the  oil,  being  about  equal  to 
a  third  or  fourth  homoBopathic  attenuation  of  iodine. 
The  value  of  this  naturally  attenuated  medicine  in  the 
treatment  of  scrofula  and  consumption,  is  at  the  pres- 

*  Paine's  Inst.  of  Med. 


90 "  HOMOEOPATHY. 

ent  time  generally  conceded.  The  analyses  of  Stein, 
De  Jongh,  and  Balard,  fully  confirm  that  of  Falker. 

The  very  minutest  quantity  of  the  natural  poison 
of  certain  animals,  the  virus  of  hydrophobia,  small 
pox,  kine-pox,  syphilis,  and  gonorrhoea,  is  sufficient, 
when  placed  in  contact  with  an  abraded  or  delicate 
surface,  or  otherwise  introduced  into  the  system,  to 
give  rise  to  all  of  their  corresponding  maladies.  Other 
diseases,  like  scabies,  leprosy,  &c.,  may  be  communica 
ted  by  the  mere  touch,  or  from  inhaling  the  breath  of 
an  infected  person. 

Miasmata,  animal  exhalations,  electricity,  magnet 
ism,  heat,  light,  and  even  mental  emotions,  are  all, 
under  certain  circumstances,  capable  of  disturbing  the 
organism  and  causing  dangerous  maladies,  and  yet,  as 
Liebig,  in  his  Animal  Chemistry,  truly  observes,  "  with 
all  our  discoveries,  we  shall  never  know  what  light, 
electricity,  and  magnetism  are  in  their  essence.  We 
can  ascertain,  however,  the  laws  which  regulate  their 
motion  and  rest,  because  these  are  manifested  in  phe 
nomena.  In  like  manner  the  laws  of  vitality,  and  of 
all  that  disturbs,  promotes,  or  alters  it,  may  certainly 
be  discovered,  although  we  shall  never  learn  what  life 
is." 

Let  it  be  ever  borne  in  mind,  that  most  substances, 
both  in  the  organic  and  inorganic  kingdoms,  possess  cer 
tain  active  principles  which  are  latent  and  unappreciable 
in  the  natural  state,  and  are  only  called  forth  and  de 
veloped  by  the  influence  of  some  agent  or  process,  which 
effects  a  transformation  or  metamorphosis  of  the  crude 
material. 

Heat,  electricity,  and  magnetism,  become  apparent 
when  certain  physical  substances  operate  upon  each 
other  in  such  a  manner  as  to  disturb  or  change  the 
original  state  of  cohesion  of  particles. 

Caloric  is  a  property  common  to  all  material  sub 
stances.  In  the  natural  state  of  these  substances,  this 
active  principle  is  latent,  and  cannot  be  appreciated 
by  the  senses  ;  but  if friction  be  used,  this  agent  is  set 
free,  and  its  power  becomes  manifest. 

Electricity  also,  pervades  all  material  bodies,  and 
only  becomes  sensible  when  the  natural  state  of  these 
bodies  is  disturbed  by  friction. 


HOMCEOPATHY. 


91 


It  is  probable,  likewise,  that  iron  and  other  sub 
stances  contain  magnetism  in  a  latent  state,  and  only 
require  the  operation  of  certain  influences,  to  deve 
lop  in  them  the  phenomena  of  magnetism.  This  is 
evident  from  the  fact,  that  u  the  same  magnet  may 
successively  magnetize  any  number  of  steel  bars, 
without  losing  any  portion  of  its  original  virtue ; 
from  which  it  follows,  that  the  magnet  communicates 
nothing  to  the  bars,  but  only  develops,  by  its  in 
fluence,  some  hidden  principle"* 

Large  quantities  of  vegetable,  animal,  or  mineral 
substances,  may  be  taken  into  the  stomach  in  a  crude 
state,  with  impunity ;  but  if  their  elementary 
particles  become  separated  by  decomposition,  or 
otherwise,  and  then  introduced  into  the  system,  they 
give  rise  to  the  most  baneful  results.  It  is  a  matter 
of  little  consequence,  whether  this  minute  subdivision 
of  particles  is  effected  by  the  action  of  solar  heat 
and  moisture,  by  trituration,  or  succussion  ;  the  ulti 
mate  effects  are  the  same':  The  elements  of  the 
substance  are  separated,  the  essence  or  medicinal 
part  is  set  free  from  the  crude,  material,  and  non-me 
dicinal  portions,  and  reduced  to  such  a  state  of  at 
tenuation  as  to  become  readily  absorbed,  and  yet 
retain  all  the  specific  qualities  pertaining  to  the  ori 
ginal  agent. 

Indeed,  so  minute  and  subtle  are  the  miasms  from 
vegetable  and  animal  decomposition,  the  exhalations 
arising  from  contagious  disorders,  &c.,  that  no  one 
has  yet  been  able  to  appreciate  their  physical  or 
chemical  properties,  by  the  most  accurate  tests  of 
chemistry  or  optics.  Who,  however,  for  this  reason, 
will  presume  to  deny  or  doubt  their  tremendous,  al 
though  mysterious,  power  upon  the  human  system  ? 

When  ether  or  chloroform  evaporates,  the  cohesion 
between  the  particles  of  the  liquid  is  destroyed  ;  its 
elements  float  in  the  air,  and  are  capable  of  impress 
ing  the  organism  in  a  much  more  powerful,  and  in  a 
totally  different  manner,  from  any  impression  which 
could  be  produced  by  these  constituents  in  a  less  at 
tenuated  state — as,  for  example,  that  of  the  original 

*  Beck's  Chemistry. 


92  HOMOEOPATHY. 

liquid.  If  a  large  quantity  of  ether  be  swallowed, 
but  slight  effects  will  result:  but  if  an  imponderable 
quantity  be  introduced  into  the  blood  through  the 
lungs,  in  the  form  of  vapour,  it  is  immediately  brought 
into  contact  with  the  brain  and  nervous  system,  and 
the  most  astonishing  effects  speedily  ensue. 

"If  the  10,240th  of  a  grain  of  tartrate  of  mercury 
be  diffused  through  the  substance  of  a  mere  hard 
sweet-pea,  the  beautiful  germ  of  a  graceful  flowering 
herb,  which  lies  folded  up  in  its  horny  pericarp,  shall 
never  come  out  and  be  expanded,  though  you  imbed 
it  in  the  softest  mould,  and  solicit  it  by  every  art." 
(Leuchs.) 

Professor  Doppler,  of  the  Royal  Institute  of  Prague, 
in  speaking  of  the  modus  operandi  of  infinitesimal 
particles,  writes  thus  :  "From  the  moment  in  which 
the  substance  of  the  atoms  succumbs  to  the  influence 
of  their  surfaces,  and  apparently  independent  of  the 
law  of  gravitation,  they  move  with  the  greatest  faci 
lity  in  every  direction,  and,  as  it  were,  become  alive  ; 
from  that  moment  only,  in  my  opinion,  drugs  acquire 
the  capacity  of  penetrating  the  organism,  and  of  ex 
citing  there  a  curative  effect.  For  if  drugs,  prepared 
in  this  manner,  be  brought  in  contact  with  the  in 
visible  extremities  of  nerves,  their  hyper-microscopi 
cal  atoms  will  enter  the  organism  at  the  same  time 
with  their  superficial  electricity,  and  will,  if  the  nerves 
be  in  a  perfectly  natural  state,  be  thrown  out  of  the 
system  without  impediment,  after  having  penetrated 
it  in  every  direction.  But  if  a  body  in  a  state  of 
health  be  accompanied  by  an  activity  of  the  nervous 
system,  perfectly  unimpeded  and  equally  free  in  every 
direction,  we  cannot,  on  the  other  side,  but  presume, 
that  in  a  state  of  imperfect  health  the  power  of  con 
duction,  proper  to  the  nervous  substance,  will  be  ma 
terially  diminished,  partially  and  in  individual  or 
gans,  either  in  consequence  of  a  chemical  change,  or 
for  some  other  reasons.  But  to  use  rather  a  mate 
rial,  but,  nevertheless,  by  no  means  unfit  comparison, 
as  streams  deposit  the  sand  and  pebbles  they  carry 
along,  on  those  spots  only  where  their  currents  meet 
with  an  impediment,  and  their  rapidity  seerns  broken 
by  obstructions,  so  in  a  similar  manner,  in  the  dis- 


HO.MCEOPATHY.  93 

eased  organism,  may  the  electric  currents,  however 
feeble,  leave  the  atoms  of  drugs  at  the  diseased  spots, 
where  they,  according  to  their  individual  properties, 
exert  either  a  curative  or  detrimental  influence." 

If,  then,  imponderable  substances  possess  powers  so 
unequivocal  and  potent  upon  the  healthy  subject, 
when  the  organs  are  in  a  high  state  of  vigour,  and 
consequently  in  a  good  condition  to  resist  the  in 
fluence  of  foreign  impressions,  why  may  we  not 
infer,  with  perfect  propriety,  that  medicinal  sub 
stances,  equally  imponderable,  are  capable  of  im 
pressing  the  organism  during  disease,  when  the  af 
fected  structures  are  unusually  susceptible  to  extra 
neous  influences  ? 

Homo30pathists  suppose  that  the  mode  in  which  their 
tenuations  operate  is  analogous  to  that  of  infection  by 
miasms ;  that  the  inert  matter  of  the  substance  is 
destroyed,  and  the  active  principle  set  free  ;  and  that 
the  smallest  quantity  of  this  active  principle,  tritu 
rated  with  sugar  of  milk,  or  diffused  in  water  or 
alcohol,  is  capable  of  communicating  to  the  vehicles 
its  properties,  and  thus  to  the  organism  its  peculiar 
action. 

The  essential  principles  of  all  vegetable  substan 
ces  constitute  but  a  very  small  proportion  of  the  ori 
ginal  crude  article,  and  the  more  perfectly  we  sepa 
rate  these  active  from  the  inactive  portions,  the  more 
pure  and  powerful  will  the  remedy  become.  Like  ca 
loric,  electricity,  and  magnetism,  the  strength  remains 
latent  in  the  crude  state  of  the  substance,  and  can 
only  be  developed  by  the  important  agency  of  heat, 
friction,  or  trituration. 

Peach-blossoms,  the  bark  of  mountain-ash,  the 
kernels  of  peaches,  cherries,  and  plums,  bitter  al 
monds,  &c.,  contain,  in  a  latent  condition,  the  active 
poison  known  as  prussic  acid,  which  may  readily 
be  obtained  from  either  of  these  articles  by  a  che 
mical  process. 

Ipecacuanha  is  indebted  for  its  virtues,  to  a  prin 
ciple  called  emetia.  Pelletier  found,  upon  analysis, 
that  the  brown  ipecacuanha  bark  contains  only  six 
teen  per  cent,  of  impure  emetia ;  and  the  red  bark 


OF  THE 
.,.-.-,  CM-TV 


94  HOMGBOFATHY. 

fourteen  per  cent.  According  to  Bergelius,  the  im 
pure  emetia  possesses  only  one-third  the  strength  of 
the  pure.  We  therefore  find,  that  of  one  hundred 
parts  of  crude  ipecacuanha,  only  five  parts  possess 
the  medicinal  virtues  of  the  drug.  Nor  is  it  at  all 
improbable,  that  farther  researches  will  enable  the 
chemist  to  free  this  principle  from  other  impurities, 
and  thus  develop  a  still  more  potent  medicine. 

Opium  contains  but  a  very  small  per  cent,  of  its 
narcotic  principle,  morphia.  The  crude  substance 
contains,  in  addition  to  morphia,  at  least  fourteen 
other  ingredients,  all  of  which  are  destitute  of  any 
particular  virtues.  Only  about  eight  or  nine  per  cent, 
of  morphia  is  obtained  from  Turkey  opium,  and  this 
is  quite  impure  and  unfit  for  use,  containing  nar- 
cotina,  &c. 

Cinchona  is  composed  of  ten  or  twelve  ingredients 
of  which,  all  but  quinia  and  cinchonia,  are  inert. 
Even  these  last,  as  usually  obtained,  are  highly  adul 
terated,  and  do  not  by  any  means  represent  the  active 
principle  of  bark  in  its  purity. 

The  same  rule  obtains  in  relation  to  most  other 
substances.  The  essential  properties  are  distributed 
but  sparingly  throughout  ligneous,  resinous,  and 
other  matters,  and  it  is  only  by  the  utmost  care  and 
nicety,  that  we  can  separate  and  develop  these  pro 
perties. 

Indeed,  there  are  many  instances  where  the  skill  of 
the  chemist  is  unable,  not  only  to  develop  artificially 
certain  principles  of  vegetable  and  animal  substances, 
but  even  to  analyze  them  when  they  become  sponta 
neously  disclosed  by  the  action  of  heat  and  moisture. 
Miasmata  and  other  noxious  exhalations  are  exam 
ples  of  this  kind. 

It  is  a  fundamental  law  of  therapeutics,  that  the  ac 
tive  properties  of  all  medicinal  substances  can  only  be 
manifested  from  their  surfaces  ;  and  it  follows  as  a 
consequence,  if  we  would  develop  the  full  powers  of 
drugs,  that  they  must  be  made  to  occupy  as  great  a 
surface  as  possible. 

]f  a  compact  piece  of  wood  be  ignited,  but  a  small 
blaze  can  be  produced;  while  if  the  same  wood  be  cut 
into  small  portions,  so  as  to  expose  a  large  surface,  and 


HOMCBOPATIIY.  95 

then  ignited,  a  large  and  powerful  flame  will  appear. 

Only  a  limited  amount  of  electricity  can  be  drawn 
from  a  given  surface  of  glass;  but  if  the  same  glass 
be  made  to  occupy  double  the  space,  an  additional 
amount  of  the  fluid  may  be  set  free. 

If  a  hole  be  rapidly  bored  through  an  ordinary  piece 
of  iron,  the  surface  of  each  chip  so  detached  will  be 
found  to  possess  magnetic  properties  ;  and  a  singular 
circumstance  connected  with  this,  is  the  fact,  that 
when  the  boring  is  accomplished  in  a  perpendicular  di 
rection,  the  chips  are  more  highly  magnetized  than 
when  it  is  effected  horizontally.  Here,  again,  is  an 
instance  where  friction  has  developed  properties  en 
tirely  unappreciable  in  the  natural  state. 

A  single  grain  of  matter  may  be  made  by  trituration 
to  pervade  every  part  of  one  hundred  grains  of  sugar 
of  milk,  and  each  molecule  thus  separated  may  be 
still  farther  subdivided  into  corpuscules,  which  in  their 
turn  may  be  diffused  intimately  through  additional 
quantities  of  the  medium.  In  this  manner  only,  can 
we  call  forth  all  of  the  latent  properties  of  drugs,  and 
reduce  them  to  that  state  of  attenuation  which  is  com 
patible  with  absorption,  and  which  enables  them  to 
exert  those  salutary  specific  influences  which  the 
homoeopathic  practitioner  so  uniformly  observes. 

Each  atom  thus  minutely  separated,  retains  the 
power  of  exercising  its  specific  influence  upon  the  or 
ganism.  Quantity  is  of  but  little  consequence,  provi 
ded  that  the  substance  is  properly  prepared  ;  for  an 
imponderable  quantity  in  its  highest  state  of  develop 
ment,  is  quite  as  capable  of  producing  its  peculiar 
effects  in  certain  conditions  of  the  body,  as  a  much 
larger  amount. 

It  is  undoubtedly  true  that  an  atom,  either  morbific 
or  medicinal,  which  possesses  an  affinity  for  a  partic 
ular  structure,  is  capable  of  communicating  to  such 
structure  its  peculiar  action,  the  influence  being  pro 
pagated  from  one  molecule  to  another,  and  each  ac 
quiring  the  properties  of  the  original  atom,  until  the 
influence  is  expended. 

Examples  of  this  kind  of  action  are  constantly  pre 
sented  to  the  physician  in  the  form  of  continuous  sym 
pathy. 


06  HOMOEOPATHY. 

One  inhalation  of  a  noxious  miasm,  under  favourable 
circumstances,  is  as  capable  of  causing  its  specific  con 
tagion,  as  a  thousand,  or  more.  One  thousandth  part 
of  a  grain  of  a  natural  or  morbid  virus,  is  as  capable 
of  imparting  the  peculiar  action  of  the  poison  to  all 
parts  of  the  organism  susceptible  to  its  influence,  as  a 
larger  quantity. 

So  also,  when  an  atom  of  a  medicine  is  absorbed 
into  the  system  and  comes  in  contact  with  an  organ  or 
tissue  already  diseased,  upon  which  it  exercises  a  spe 
cific  influence,  it  communicates  to  the  surrounding 
atoms  its  peculiar  action  until  the  whole  tissue  is  in 
volved,  and  thus,  if  the  remedy  be  homoeopathic  to 
the  malady,  it  will  supersede  the  primary  affection. 

La  Place  and  Berthollet  have  advanced  the  opinion, 
that  "  a  molecule,  being  put  in  motion,  can  communi 
cate  its  motion  to  others,  if  in  contact  with  them." 

This  law  is  applicable  to  both  animate  and  inani 
mate  matter,  under  certain  circumstances.  Thus,  the 
smallest  point  of  decayed  vegetable  or  animal  mat 
ter,  if  placed  in  contact  with  healthy  vegetable  or  ani 
mal  substances  for  which  it  has  an  affinity,  will  com 
municate  to  the  latter  its  own  morbid  action. 

The  smallest  point  of  decay  in  a  tooth,  continually 
propagates  its  peculiar  action  to  the  surrounding  parts 
until  the  whole  tooth  is  destroyed,  or  the  diseased  por 
tion  is  removed. 

The  slightest  spark  of  fire,  put  in  contact  with  a  com 
bustible  material,  communicates  its  action  to  all  parts 
susceptible  of  combustion. 

A  minute  nucleus  being  once  formed  in  the  mineral 
kingdom,  possesses  the  power  of  attracting  to  itself  in 
a  regular  and  uniform  arrangement,  all  of  those  par 
ticles  near  it,  for  which  it  has  an  affinity,  and  the  dif 
ferent  varieties  of  minerals  communicate  to  these  par 
ticles  their  own  peculiar  action  and  arrangement. 

It  is  asserted  by  the  supporters  of  the  chemical  hy 
pothesis;  "  that  substances  in  a  state  of  putrefac 
tion,  by  entering  the  blood,  impart  their  peculiar  action 
to  the  constituents  of  that  fluid,  and  all  the  sub 
stances  of  the  body  are  induced  to  undergo  a  modified 
putrefaction."*  Liebig  affirms  that  "  a  body,  the  atoms 

*  Paris  Pharmacologia. 


HOMOEOPATHY.  97 

of  which  are  in  a  state  of  transformation,  may  impart 
its  peculiar  condition  to  compounds  with  which  it  may 
happen  to  communicate." 

These  assertions,  however,  are  not  sustained  by 
facts.  There  is  no  proof  that  the  blood  becomes  con 
taminated  by  the  atoms  which  enter  it  in  a  state  of 
transformation  ;  nor  is  there  any  proof  that  such 
atoms  are  capable  of  "  imparting  their  peculiar  con 
ditions,"  indifferently  to  other  "  compounds  with 
which  they  may  happen  to  communrcate." 

Every  substance  in  nature,  whether  morbific  or 
medicinal,  possesses  its  own  characteristic  and  dis 
tinct  mode  of  action,  and  is  only  able  to  exercise  or 
communicate  this  action,  in  a  specific  manner,  to 
particular  structures.  Thus,  the  contagion  of  scarla 
tina  imparts  its  peculiar  action  to  the  throat  and  skin. 
The  contagion  of  scabies  acts  exclusively  upon  the 
skin.  The  miasms  which  occasion  many  kinds  of 
fever,  appear  to  expend  their  effects  upon  the  nervous 
system.  The  virus  of  gonorrhoea  is  specific  and  uni 
form  in  its  results  upon  the  mucous  membrane  of  the 
urethra.  The  virus  of  syphilis,  although  more  gene 
ral  in  its  operation,  affects  only  a  certain  class  of 
structures.  All  of  these  poisonous  matters  are  incapa 
ble  of  imparting  their  peculiar  influence,  unless  they  are 
brought  intp  contact  with  those  tissues  for  which  they 
possess  a  "  kind  of  elective  affinity"  There  is  no  rea 
son  to  suppose,  that  in  any  instance  we  have  named,  the 
blood  itself  is  contaminated,  but  it  serves  merely  as 
the  vehicle  which  conveys  the  morbid  particles  to  the 
different  parts  of  the  body. 

What  we  have  advanced  in  regard  to  the  modus 
opcrandi  of  morbific,  is  equally  true  of  medicinal 
agents.  We  have  before  shown  that  most  drugs  pos 
sess  well-defined  specific  actions,  which  can  only  be 
manifested  after  having  been  conveyed  by  the  blood 
to  their  destined  structures. 

It  will  be  perceived  that  the  views  here  advanced 
in  regard  to  the  mode  of  operation  of  morbific  and 
medicinal  agents,  differ  essentially,  not  only  from 
those  of  the  chemical  school,  but  also  from  those  of 
most  writers  who  havf  hitherto  appeared  as  advo- 


88  HOMOEOPATHY. 

cates  of  homoeopathy.  From  quotations  made  at 
page  22,  it  will  be  observed  that  Hahnemann  himself 
is  a  firm  advocate  of  the  "  vital  theory."  In  common 
with  many  distinguished  writers  of  the  old  school,  he 
supposes  all  diseases  to  consist  of  certain  alterations 
of  the  ;<  vital  properties  "  of  parts,  and  that  medicines 
cure  these  diseases  by  acting  upon  these  (supposed) 
immaterial  properties  in  such  a  manner  as  to  restore 
them  to  a  normal  state.  In  advocating  these  doc 
trines,  Hahnemann  has  virtually  rejected  the  theory 
of  absorption,  the  truth  of  which  has  been  so  amply 
verified  by  Muller,  Pereira,  Blake,  &c.,  and  thus  has 
marred  a  portion  of  his  beautiful  system. 

It  may  seem  impossible,  at  a  first  view,  that  attenuated 
drugs  can  be  absorbed  into  the  system,  and  exert  their 
influence  topically  on  the  different  structures  ;  but  in 
support  of  this  opinion  we  beg  leave  to  submit  the 
following  ideas. 

Medicines,  as  has  been  previously  remarked,  are 
often  detected  in  those  structures  on  which  they  have 
exerted  their  effects.  Mercury,  iodine,  sulphur,  nitrate 
of  silver,  the  salts  of  lead,  iron,  bismuth,  copper,  &c., 
have  all  been  found  in  different  tissues  of  the  econ 
omy  ;  and  even  Liebig  himself  advises  us  that  many 
of  these  substances  often  form  "  permanent  com 
pounds  with  the  different  tissues."  The  same  author 
also  remarks,  "  if  by  the  introduction  of  a  substance 
certain  abnormal  conditions  are  rendered  normal,  it 
will  be  impossible  to  reject  the  opinion,  that  this  phe 
nomena  depends  on  a  change  in  the  composition  of 
the  constituents  of  the  diseased  organism,  a  change  in 
which  the  elements  of  the  remedy  take  a  share." 

The  elements  of  the  remedy  do  most  certainly  take 
a  share  in  this  change,  but  only  so  far  as  the  disorder 
ed  organ  or  tissue  is  concerned.  It  matters  not  whe 
ther  the  specific  agent  be  imponderable  in  quantity, 
administered  through  the  kings,  stomach,  or  skin,  or  in 
jected  into  the  veins ;  it  seeks  that  part  for  which  it 
has  an  affinity,  and  there  manifests  its  force. 

I  have  known  persons  to  become  salivated  by  the 
use  of  less  than  one-half  of  a  grain  of  the  first  tritura- 
tion  of  corrosive  sublimate,  given  in  divided  doses. 
This  ran  be  explained  in  no  other  way  than  by 


HOMOEOPATHY.  99 

supposing  that  the  remedy  is  rendered  innoxious  to 
the  absorbent  vessels  by  the  peculiar  mode  of  prepa 
ration  ;  for  so  small  a  quantity  of  the  crude  article 
has  never,  to  our  knowledge,  been  known  to  produce 
this  result.  By  trituration,  the  crude  particles  of  the 
mineral  are  so  minutely  separated  and  diffused 
through  the  vehicle,  that  the  delicate  absorbents  ad 
mit  them  into  the  circulation  with  facility,  while  in 
an  unprepared  state  the  remedy  would  be  recognised 
as  an  irritant,  and  consequently  excluded. 

When  salivation  is  produced  by  large  doses  of  ca 
lomel,  or  blue-mass,  it  is  highly  probable  that  evapo- 
roiion  occurs  from  the  heat  of  the  stomach  and  intes 
tines,  and  that  this  vapour,  impregnating  the  chyle,  is 
absorbed.  It  has  been  said  by  the  opponents  of  ab 
sorption,  that  the  preparations  of  mercury  cannot  be 
absorbed  on  account  of  their  insoluble  nature,  and 
therefore  that  salivation  is  caused  by  an  impression 
which  is  made  upon  the  "  vital  properties"  of  the 
stomach,  and  that  this  impression  is  reflected  to  the 
salivary  glands,  through  the  sympathetic  nerves.  But 
if  the  advocates  of  this  doctrine  will  reflect  that  mer 
cury  evaporates  at  a  common  temperature,  and  that 
this  vapour,  when  inhaled,  exerts  all  the  specific  ef 
fects  of  the  mineral,  they  must  admit  that  when  sub 
mitted  to  the  higher  temperature  of  the  stomach  and 
bowels,  this  evaporation  and  absorption  will  be  aug 
mented.  "  I  believe,"  says  Pereira,  "  with  Buchan, 
Orfila.  and  others,  that  metallic  mercury,  in  the  finely 
divided  state  in  which  it  must  exist  as  vapour,  is  itself 
poisonous" 

An  argument  which  we  deem  conclusive  upon  this 
point,  is  from  the  fact  that  traces  of  mercury  itself  have 
often  been  detected  in  the  secretions,  excretions,  and 
solids  of  the  body ;  and  if  any  "  vital  properties " 
have  reflected  the  influence,  they  must  have  conveyed 
the  solid  substance  along  bodily  to  the  affected  glands, 
etc. 

In  considering  the  subject  of  absorption  and  the 
topical  action  of  attenuated  drugs,  it  must  be  remem 
bered  that  the  absorbing  structures  are  very  delicate 
and  sensitive,  so  that  they  are  enabled  to  exclude  all 
crude  and  irritating  substances  :  and  also  that  the  ex- 


100  HOMCEOPATHY. 

treme  terminations  of  the  nerves,  in  all  parts  of  the 
body,  are  exquisitely  susceptible  to  the  influence  of 
specific  foreign  agents ;  and  a  cause  capable  of 
affecting  powerfully  these  minute  filaments,  would  be 
entirely  without  energy  and  unappreciated,  if  brought 
to  bear  upon  the  trunk  or  larger  branches  of  the  same 
nerve. 

Another  fact  illustrative  of  the  truth  of  absorption 
and  topical  action  is,  that  substances  always  exercise 
their  specific  effects  more  promptly  and  potently  when 
introduced  directly  into  the  mass  of  the  blood,  than 
when  taken  by  the  stomach.  "  Medicinal  or  poison 
ous  agents,  injected  into  the  blood-vessels,  exert  the 
same  kind  of  specific  influence  over  the  functions  of 
certain  organs,  as  when  they  are  administered  in  the 
usual  way,  but  that  their  influence  is  more  potent."* 

Liebig  also  assures  us,  that  "  we  can  by  remedial 
agents  exercise  an  influence  on  every  part  of  an  organ 
by  substances  possessing  a  well-defined  chemical  ac 
tion." 

Here  is  a  distinct  recognition  of  the  principle  of 
the  topical  or  specific  action  of  remedial  agents,  al 
though  the  character  of  this  action  is  supposed  to  be 
chemical.  Without  entering  into  any  discussion  upon 
this  point,  or  attempting  to  explain  how  morbific  or 
remedial  agents  produce  their  peculiar  effects,  we 
shall  remain  satisfied  with  the  positions  we  have  be 
fore  laid  down,  and  simply  refer  our  readers  to  the 
numerous  instances,  within  their  own  knowledge,  of 
the  topical  action  of  substances,  both  ponderable  and 
imponderable,  with  the  addition  of  a  few  examples  of 
the  latter,  which  can  be  understood  and  appreciated 
by  all. 

1st.  Odours.  When  odoriferous  particles  are  brought 
into  contact  with  a  certain  nasal  structure,  (the  schnei- 
derian  membrane,)  the  minute  and  sensitive  nerves  of 
the  part  take  cognizance  of  the  stimulus,  a  decided 
impression  is  made  upon  the  whole  membrane,  and 
an  odour,  agreeable  or  otherwise,  according  to  the 
nature  of  the  exciting  cause,  is  the  result.  In  this 
instance,  physical,  but  imponderable  particles,  operate 

*  Pcreira,  Mnt,  Mod.  and  Tlier. 


HOMCEOPATHY.  101 

upon  the  nasal  tissue  by  absolute  contact,  and  impart 
that  peculiar  action  which  enables  us  to  appreciate 
odours. 

2d,  Light.  According  to  Sir  Isaac  Newton,  light  is 
a  physical,  but  imponderable  compound,  and  can  only 
manifest  its  power  when  its  atoms  are  in  contact  with 
the  organ  of  sight.  These  particles  of  light  are  the 
natural  stimulus  of  the  eye, — material,  imponderable, 
specific.  When  this  compound  is  separated  into  the 
different  primary  rays,  each  particular  ray,  when 
brought  into  contact  with  the  eye,  exercises  a  special 
and  distinct  influence,  giving  rise  to  the  perfect  ap 
preciation  of  the  different  colours  of  the  prism.  Here 
again  we  are  presented  with  an  example  of  the  spe 
cific  influence  of  imponderable  atoms  upon  a  certain 
part  of  the  system. 

3d,  Caloric.  Newton  also  maintained  that  caloric  is 
"  a  distinct  material  substance,  the  particles  of  which 
repel  one  another,  and  are  attracted  by  all  other  sub 
stances." 

When  caloric  is  given  off  by  a  heated  body,  its 
atoms  impart  to  all  other  atoms  with  which  it  comes 
in  contact,  its  o\vn  peculiar  action,  and  the  sensation 
of  heat,  with  its  attendant  phenomena,  expansion, 
&c.,  is  the  consequence.  Here  we  are  afforded  with 
a  still  more  striking  instance  of  the  power  of  an  im 
ponderable  substance  in  altering  and  modifying  the 
character  and  properties  of  all  substances  upon  which 
it  exercises  its  action.  This  active  principle,  present 
in  all  bodies,  hidden  and  unappreciable  except  when 
set  free  by  friction,  percussion,  mixture,  electricity,  or 
combustion,  possesses  properties  when  thus  liberated, 
surpassing  in  power  and  influence  every  other  sub 
stance  in  nature  ;  yet  it  is  more  subtle  and  imponder 
able  than  the  most  attenuated  medicines  of  homreo- 
pathy. 

4th.  Electricity,  galvanism,  magnetism,  and  the  va 
rious  gases,  are  all  material  substances,  and  manifest 
their  influence  physically  by  contact  with  the  body. 

It  must  not  be  supposed  that  light,  heat,  electricity, 
magnetism,  etc.,  are  immaterial  nothings — mere  pro 
perties  of  matter — because  they  cannot  be  weighed^ 
handled,  and  made  subservient  to  all  of  those 


102  HOMOEOPATHY. 

which  govern  more  crude  substances.  Nor  must  it 
be  supposed  of  drugs,  that  they  possess  no  qualities 
except  those  which  are  apparent  in  the  crude  state, 
and  can  be  fully  appreciated  by  their  nauseousness 
of  taste,  rankness  of  smell,  or  power  of  raking  the 
stomach  and  intestines. 

Modern  science  has  demonstrated,  that  by  friction, 
percussion,  mixture,  &c.,  some  of  the  most  powerful 
principles  known  may  be  liberated  from  substances, 
which,  in  a  crude  state,  are  entirely  harmless.  It 
has  shown,  that  the  more  perfectly  we  can  disencum 
ber  these  principles  from  their  inactive  envelopes,  the 
more  potent  they  become.  It  has  shown  that  the 
mass  of  ligneous,  resinous,  starchy,  fatty,  extractive, 
and  colouring  matters,  which  surround  and  enclose 
the  active  portions  of  vegetable  substances,  instead 
of  possessing  medicinal  properties,  serve  only  to  nau 
seate  and  oppress  the  stomach  and  bowels,  and  thus 
complicate  any  existing  malady. 

Pereira,  and  other  authors  opposed  to  our  system, 
have  endeavoured  to  cover  it  with  ridicule  by  entering 
into  a  computation  respecting  the  weight  and  strength 
of  the  different  attenuations.  They  have  displayed 
before  us  tabular  views  showing  the  strength  of  each 
attenuation,  and  then  assured  us,  without  the  trouble 
of  testing  the  question  practically,  that  such  exceed 
ingly  small  doses  of  medicines  can  produce  no  effect 
upon  the  system,  but  "  that  the  supposed  homoeopathic 
cures  are  referable  to  a  natural  and  spontaneous  cure, 
aided,  in  many  cases,  by  a  strict  attention  to  diet  and 
regimen."*  This  is  the  principal  argument  urged 
against  the  therapeutical  doctrines  of  Hahnemann. 

We  beg  leave,  however,  to  request  those  gentlemen 
who  judge  of  the  potency  of  substances  by  their 
weight  and  dimensions,  to  enter  into  a  still  further  cal 
culation,  and  inform  us  which  possesses  the  greatest 
weight,  the  medicinal  particles  pertaining  to  a  drop  of 
a  thirtieth  attenuation  of  homoeopathy,  or  the  charge 
of  electricity,  which  lays  prostrate  and  senseless  the 
strongest  man — or  the  quantity  of  sulphuretted  hydro 
gen,  or  carbonic  acid  gas,  requisite  to  cause  immediate 

*  Pereira's  Mat.  Med.  and  Ther. 


HOMCEOPATHY.  103 

death  when  inhaled  ?  Which  can  be  most  readily 
detected  and  appreciated  by  analysis,  the  atoms  of  a 
high  attenuation  of  Hahnemann,  or  the  deleterious 
miasms  which  arise  from  vegetable  or  animal  decom 
position  ? 

Which  present  the  greatest  difficulties  in  examina 
tion  and  description,  the  physical  structure  of  the  par 
ticles  of  a  homoeopathic  medicament,  or  that  of  ca 
loric,  or  light  ? 

Will  the  respectable  Hippocratic,  who  cannot  re 
cognise  power  in  any  material  substance,  unless  it  can 
be  weighed  or  handled,  enter  into  a  computation,  and 
inform  us  how  much  a  poisonous  dose  of  the  vapour  of 
hydrocyanic  acid,  mercury,  or  lead,  weighs  ? 

Let  it  be  remembered,  that  not  one  atom  of  matter 
in  the  whole  universe  can  be  annihilated :  transfor 
mations  may  be  effected — the  cohesion  of  particles 
may  be  changed* — atoms  in  their  ultimate  state  of 
chemical  combination  may  be  physically  divided  into 
molecules,  and  again  subdivided  into  lesser  atoms  to 
such  an  extent  as  to  baffle  detection  from  the  most 
perfect  tests  of  chemistry  or  optics- — new  powers  may 
be  developed  in  these  atoms,  the  exact  operation  of 
which  we  may  not  at  present  be  able  to  understand, 
but  in  no  instance  can  we  destroy  one  single  particle 
of  matter.  We  may  effect  an  entire  metamorphosis 
of  almost  any  solid  substance,  and  diffuse  its  elements 
in  such  a  manner  as  to  occupy  and  affect  a  very  large 
amount  of  space.  The  elements  of  a  few  grains  of 
gunpowder  may  be  made  with  the  aid  of  a  few  im 
ponderable  particles  of  caloric,  to  change  their  form, 
and  impregnate  every  portion  of  the  atmosphere  of  a 
large  room.  In  like  manner,  a  single  grain  of  a  vege 
table  or  mineral  substance  may  be  transformed,  and 
its  atoms  diffused  throughout  large  quantities  of  inert 
materials,  in  such  a  manner  as  to  impregnate  them 
in  every  part  with  medicinal  properties,  but  in  no  in 
stance  can  a  single  atom  be  annihilated.  Until  we 
arrive  at  more  accurate  knowledge  in  relation  to  the 
laws  which  govern  the  chemical  and  physical  action 
of  the  minute  atoms  of  substances  than  we  at  present 

*  See  Atomic  Theories. 


104  HOMCEOL'ATHY. 

possess,  let  us  not  deny  that  they  may  be  endowed 
with  properties  and  powers,  (although  their  modus 
medendi  is  a  mystery  to  us,)  capable  of  exercising  an 
important  influence  upon  the  human  organism. 

In  regard  to  the  preparation  of  medicines,  there  are 
several  points  of  difference  worthy  of  particular  no 
tice,  between  the  old  and  new  schools. 

1.  Allopathy  employs  her   drugs  in   a  crude  and 
consequently  inactive  form  ;  wrhile  homoeopathy  makes 
use  only  of  their  pure  essential  principles,  unencum 
bered  by  foreign  matters. 

2.  Allopathy  employs  so  great  an  amount  of  arti 
ficial  heat  in  her  pharmaceutical  operations,  that  a 
large  proportion  of  the  active  properties  of  her  drugs 
is    expended    in    evaporation ;     while    homo3opathy 
makes  use  only  of  expression,  trituration,  and  suc- 
cussion,  and  thus  not  only  retains  all  of  the  virtues  in 
herent  in  the  drug,  but   actually    develops    powers 
which  would  have  remained  latent  under  other  cir 
cumstances. 

3.  On  account  of  the  peculiar  mode  of  prepara 
tion,  the  remedies'  of  allopathy  are  offensive  to  the 
taste,  nauseous  to  the  stomach,  and  by  their  indigest 
ible  and  irritating  qualities,  serve  directly  to  induce 
gastric  and  intestinal  derangements,  and  other  serious 
medicinal  symptoms.     The  medicines  of  homoeopathy 
are  liable  to  none  of  these  objections. 

4.  For    the  reasons  above   enumerated,  many  of 
the  remedies  of  the  old  school  are  excluded  by  the 
sensitive   absorbents,  on   account  of  their   irritating 
qualities,  and  are  thrown  off  with  the  faecal  matters 
as  foreign  substances  ;  having  failed,  in  their  passage 
through  the  intestinal  canal,  of  producing  any  other 
effect    than   an     irritation    of   the    gastrointestinal 
membrane.    The  attenuated  remedies  of  homoeopathy, 
being  innocuous  to  the  Jacteals  and  absorbents,  are 
readily  admitted  into  the  circulation  and  conveyed  to 
those  parts  upon  which  they  exert  a  specific  action, 
thus  impressing  directly  the  organs  or  tissues  actually 
diseased.     "  No  substances,"  says  Martyn  Paine,  in  his 
Institutes  of  Medicine,  "  but  such  as  exist  in  a  fluid  or 
very  attenuated  state,  are  taken  up  by  the  lacteal s  and 
absorbents." 


HOMOEOPATHY.  105 

So,  also,  in  the  therapeutical  application  of  reme 
dies,  \ve  claim,  as  far  as  accurate  scientific  principles 
and  sound  philosophy  are  concerned,  that  homoeo 
pathy  is  vastly  superior  to  allopathy.  We  shall 
briefly  reiterate  some  of  the  more  prominent  points 
of  difference  in  the  practice  of  the  two  schools. 

The  system  of  homoeopathy  is  founded  upon  ra 
tional  and  scientific  principles,  inasmuch  as  its 
remedies  are  exhibited  with  a  definite  object,  and  the 
results  can  in  most  cases  be  predicted  with  mathe 
matical  certainty. 

The  practice  of  allopathy  must  always  be  indirect, 
uncertain,  and  empirical.  The  violence  of  the  re 
medies  employed,  necessarily  induces  medicinal  and 
sympathetic  affections,  which,  mingling  with  the 
symptoms  of  the  natural  disease,  render  it  impossible 
to  distinguish  between  the  two  classes  of  symptoms, 
or  to  judge  whether  the  malady,  or  the  medicine,  or 
both  combined,  are  killing  the  patient.  The  fact* 
that  so  few  allopathic  practitioners  coincide  precisely 
in  regard  to  the  treatment  of  very  many  diseases, 
proves  conclusively  that  their  system  is  one  of  guess 
ing,  rather  than  one  founded  on  scientific  knowledge 
and  ascertained  facts. 

Homoeopathic  remedies  being  specific  and  certain 
in  their  effects,  operate  only  upon  those  parts  which 
are  actually  diseased.  Without  inflaming  healthy 
structures,  debilitating  the  system,  or  disturbing  the 
function  of  any  organ,  they  induce,  when  judiciously 
exhibited,  a  new  or  alterative  action  in  the  part  af 
fected,  of  just  sufficient  severity  to  banish  the  natural 
malady,  while  the  new  or  medicinal  action  subsides 
speedily  and  spontaneously. 

According  to  the  doctrines  of  homoeopathy,  no  two 
diseases  or  kinds  of  inflammation  can  exist  in  the 
same  structure  at  the  same  time ;  for  whenever  two 
exciting  causes  act  upon  the  same  part,  the  one  pos 
sessing  the  most  powerful  action,  must  necessarily 
banish  and  supersede  the  weaker.  Therefore,  in  ac 
cordance  with  the  rules  of  our  system,  remedial  im 
pressions  are  always  made  directly  upon  the  organ 
or  tissue  affected,  and  a  new  kind  of  action  set  up 
5* 


106  HOMCEOPATHY. 

which  abolishes  the  disease  and  usurps  temporarily 
its  place. 

According  to  the  strict  tenets  of  the  old  school, 
remedies  should  be  exhibited  in  such  a  manner  as  to 
impress  structures  which  are  healthy  and  remote  from 
the  organ  or  tissue  diseased,  in  order  that  revulsive, 
derivative,  or  counter-irritating  effects  may  be  pro 
duced,  and  thus  serve  to  attract  the  fluids  from  the 
natural  affection  to  the  artificial  one.  This  plan  of 
treatment  originated,  as  we  have  seen,  from  the  sup 
position  that  no  two  maladies  of  consequence  could 
exist  in  different  parts  of  the  same  organism  at  the 
same  time.  As  this  idea  is  at  present  universally  con 
ceded  to  be  erroneous,  we  assert  that  a  mode  of  prac 
tice  deduced  from  such  false  data,  must  of  necessity 
be  unscientific  and  empirical. 

By  operating  on  healthy  structures,  the  allopath  ac 
complishes  little  or  nothing  towards  restoring  the  im 
paired  capillaries  of  the  affected  part  to  their  ori 
ginal  condition  of  strength  and  resistance,  and  con 
sequently  his  system  must  be  entirely  inadequate  to 
effect  cures.  We  are,  for  this  reason,  forced  to  the 
conclusion  that  the  modern  Celsus,  Dr.  Forbes,  is  cor 
rect  when  he  asserts,  that  "  in  a  large  proportion  of 
the  cases  treated  by  allopathic  physicians,  the  disease 
is  cured  by  nature,  and  not  by  them." 

It  is  a  fundamental  law  of  medicine,  that  no  in 
flammation  can  be  created  in  any  part  of  the  body, 
without  giving  rise  to  secondary  sympathetic  affec 
tions  in  other  and  distant  parts.  It  is  evident,  there 
fore,  that  the  greater  the  number  of  structures 
affected  with  inflammation,  whether  natural  or  arti 
ficial,  the  greater  will  be  the  number  of  sympathetic 
symptoms,  and  consequently  the  more  serious  and 
complicated  the  malady.  Thus  we  perceive  the 
force  of  Dr.  Forbes'  remark,  "  that  in  not  a  small  pro 
portion  of  the  cases  treated  by  the  physicians  of  the 
old  school,  the  disease  is  cured  by  nature,  in  spite  of 
them ;  in  other  words,  their  interference  opposing, 
instead  of  assisting,  Ihe  cure." 

We  have  before  shown  that  organs  and  tissues  be 
come  morbidly  susceptible  to  the  impressions  of  spe 
cific  remedial  agents  during  inflammation  ;  therefore  it 


HOMOEOPATHY.  107 

is  that  extremely  minute  quantities  of  specific  medica 
ments  are  capable  of  exercising  powerful  influences 
daring  disease,  which,  under  circumstances  of  health, 
would  be  productive  of  no  effects  whatsoever.  This 
is  a  truth  of  vast  importance  in  the  administration  of 
medicines,  and  should  be  thoroughly  appreciated  by 
the  practitioner  who  regards  the  welfare  of  his  pa 
tients.  Let  him  remember  that  these  acquired  sus 
ceptibilities  are  so  great,  that  even  the  natural  stimuli, 
food,  gastric  juice,  bile,  light,  &c.,  cannot  be  tolerated  ; 
and  from  this  fact,  take  warning  lest  he  inflicts  injury 
and  counteracts  the  efforts  of  nature,  by  too  active 
medicines. 

But  as  we  have  so  frequently  observed,  it  is  not  so 
much  our  principle  of  cure,  at  which  the  shafts  of  the 
old  school  are  directed,  as  to  the  doctrine  of  small 
doses.  It  is  not  because  the  adherents  of  allopathy 
cannot  make  themselves  acquainted  with  the  powers 
of  attenuated  drugs,  but  it  is  because  their  inveterate 
prejudices  will  not  allow  them  to  investigate  the  facts 
which  are  involved.  They  prefer  to  die  of  vomiting, 
purging,  and  sweating,  as  their  predecessors  have  done 
for  two  thousand  years,  rather  than  to  be  cured  quietly 
under  a  new  system.  These  individuals  are  not  satisfied 
unless  they  feel  and  see  the  poor  body  writhe  and  suffer 
for  the  sin  of  being  sick.  What  care  they  for  any 
interior  or  invisible  action  of  a  medicine,  when  they 
can  be  cut.  racked,  and  tortured,  by  the  lancet,  emetics, 
cathartics,  blisters  and  moxas,  and  that  too,  secundem 
artem  ?  To  be  sure,  they  were  not  aware  of  any  visible 
effects  when  the  morbid  agent  operated  upon  their  sys 
tems  to  produce  the  disease,  but  the  curative  part  is  in 
their  own  hands,  and  they  are  determined  to  exercise 
their  privilege  of  a  full  and  continual  appreciation  of 
the  whole  modus  operandi  of  the  remedial  process. 
This  part,  nature  has  no  power  to  cheat  them  of,  but 
Hippocrates  now  reigns,  and  they  are  resolved  to  exer 
cise  their  ancient  reserved  rights,  and  bleed,  puke, 
purge,  sweat  and  blister,  ad  libitum. 

But  why  have  our  opponents  dwelt  so  much  upon 
our  doses  ?  Does  not  every  homoeopath  aim  and  intend 
to  give  a  sufficient  quantity  of  the  medicine  at  a  time, 
to  effect  a  speedy  cure  ;  and  is  not  this  quantity  deter- 


108  HOMOEOPATHY. 

mined  by  experience  of  simple  facts  ?     We  have  dif 
ferent  strengths  or  attenuations  of  each  medicine,  from 
the  strongest  tincture  up  to  the  most  minute  attenua 
tions,  and  every  homoeopath  selects  that  strength  or 
attenuation  of  the  drug  which  most  speedily  and  safely 
cures  his  patient.     The  great  point  with  him  is,  to  se 
lect  such  a  medicine  as  shall  be  homoeopathic  to  the 
symptoms  of  the  disease,  and  then  to  administer  just 
enough  of  it  to  effect  his  object  in  the   most  safe  and 
speedy  manner.     He  finds  by  experience — by  a  mass  of 
facts — that  the  tinctures  and  alkaloids,  although  often 
capable  of  subduing  disease,  are  less  prompt,  less  effi 
cient,  and  less  safe  than  weaker  preparations  of  the 
drug.     This  easily  demonstrated  truth,  was  not  the  re 
sult  of  theory  or  hypothesis,  but  originated  with  Hah 
nemann,  as  we  have  already  seen,  through  necessity, 
on  discovering  that  the  tinctures  which  \vere  first  em 
ployed  by  him,  in  accordance  with  his  principle,  often 
produced  too  violent  impressions  upon  the  affected  struc 
tures.     What  cared  Hahnemann — what  care  his  disci 
ples — whether  they  use  one  or  twenty  drops  of  a  tincture, 
or  one  grain  of  a  twentieth  attenuation  ?     Were  twen 
ty  drops  of  a  tincture,  or  twenty  grains  of  a  crude  sub 
stance,  more  efficient  in  curing  sickness  than  one  drop 
or  one  grain  of  an  attenuation,  is  there  any  man  who 
supposes  that  Hahnemann  or  his  followers  would  not 
have  administered  them  in  this  form,  in  preference  to 
any  other  ?     The  chief  glory  of  the  founder  of  homoeo 
pathy   does  not  consist  in  the  discovery  of  the  efficacy 
of  small  doses,  but  in  the  demonstration  and  practical 
introduction  of  the  great  doctrine  of  curing  maladies 
by  impressing  diseased  tissues  with  medicines  which 
operate  specifically  upon  these  tissues  themselves,  ra 
ther  than  on  distant  parts. 

It  matters  not,  therefore,  in  regard  to  the  homoeopa 
thic  law  of  cure,  whether  we  use  this  or  that  strength, 
provided  the  remedy  is  homoeopathic  to  the  disease, 
and  exactly  the  requisite  impression  is  produced  upon 
the  affected  parts.  The  man  who  cures  a  belladonna 
headache  with  ten  drops  of  the  tincture,  adheres  to  si- 
milia  similibus  as  much  as  he  who  cures  with  the  thir 
tieth  attenuation  of  the  medicine.  The  only  question 
to  be  decided  is,  which  strength  cures  most  safely  and 


HOMOEOPATHY.  109 

• 

quickly  ;  and  if  facts  prove,  as  all  homoeopaths  believe, 
that  a  preparation  weaker  than  the  tincture  is  by  far  the 
most  safe  and  efficient,  then  it  is  our  duty  to  give  these 
preparations  the  preference.  It  is  found,  for  example, 
when  repeated  doses  of  tincture  of  belladonna  are 
given  in  acute  inflammation  of  the  brain,  that  the  pri 
mary  symptoms  from  the  drug  manifest  themselves  too 
violently — that  it  causes  dangerous  and  protracted  me 
dicinal  aggravation,  and  a  tardy  re-action  of  the  organ 
ism  ;  while  a  dilution  of  the  remedy  impresses  mildly  the 
diseased  structure,  causing  scarcely  perceptible  pri 
mary  symptoms,  and  is  speedily  followed  by  its  seconda 
ry  or  curative  effects. 

We  shall  conclude  this  chapter  by  quoting  a  few 
observations  of  the  distinguished  modern  chemist  (an 
allopathist)  Kane,  respecting  the  divisibility  of  matter, 
and  some  of  the  phenomena  witnessed  when  a  very 
high  state  of  attenuation  has  been  arrived  at.  We  make 
these  extracts  for  the  benefit  of  those  whose  "  bundles 
of  ideas"  are  not  already  made  up,  trusting  at  least, 
that  they  may  have  the  effect  of  demonstrating  to  such 
persons,  that,  not  only  morbific  and  medicinal  powder 
may  exist  in  infinitesimal  atoms  of  matter,  but  even 
life  itself. 

"  It  has  been  proved  that  gold  may  be  divided  into 
particles  of  at  least  Moojmo<x>  of  a  square  inch,  and  yet 
possess  the  colour  and  all  other  characters  of  the 
largest  mass.  If  a  grain  of  copper  be  dissolved  in  ni 
tric  acid,  and  then  in  water  of  ammonia,  it  will  give  a 
decided  violet  colour  to  392  cubic  inches  of  water. 
Even  supposing  that  each  portion  of  the  liquor  of  the 
size  of  a  grain  of  sand,  and  of  which  there  are  a  mil 
lion  in  a  cubic  inch,  contains  only  one  particle  of  cop 
per,  the  grain  must  have  divided  itself  into  392  million 
parts.  .  A  single  drop  of  a  strong  solution  of  indigo, 
wherein  at  least  500,000  distinctly  visible  portions  can 
be  shown,  colours  1,000  cubic  inches  of  water  ;  and  as 
this  mass  of  water  contains  certainly  500,000  times 
the  bulk  of  the  drop  of  the  indigo  solution,  the  par 
ticles  of  indigo  must  be  smaller  than  ^00,00^000,000  the 
twenty-five  hundred  millionth  of  a  cubic  inch.  A  ra 
ther  more  distinct  experiment  is  the  following  :  if  we 
dissolve  a  fragment  of  silver,  of  0.01  of  a  cubic  line  in 


110  HOMCEOPATHY. 

size,  in  nitric  acid,  it  will  render  distinctly  milky,  500 
cubic  inches  of  a  clear  solution  of  common  salt. 
Hence  the  magnitude  of  each  particle  of  silver  cannot 
exceed,  but  must  rather  fall  far  short  of  a  billionth  of 
a  cubic  line.  To  render  the  idea  of  this  degree  of  di 
vision  more  distinct  than  the  mere  mention  of  so  im 
perfectly  conceivable  a  number  as  a  billion  could  af 
fect,  it  may  be  added,  that  a  man,  to  reckon  with  a 
watch,  counting  day  and  night,  a  single  billion  of  se 
conds,  would  require  31,675  years." 

According  to  Doppler,  a  cubic  inch  of  brimstone, 
broken  into  a  million  equal  pieces,  a  sand  grain  each 
in  size,  is  magnified  in  sensible  surface  from  six  square 
inches  to  more  than  six  square  feet.  It  is  calculable 
in  this  way,  that,  if  each  trituration  of  the  homoso- 
pathist  diminishes  his  drug  a  hundred  times  (an  ex 
tremely  moderate  allowance),  the  sensible  surface  of  a 
single  inch  of  sulphur,  or  any  other  drug,  shall  be  two 
square  miles  at  the  third  trituration. 

"In  the  organized  kingdoms  of  nature,  even  this  ex 
cessive  tenuity  of  matter  is  far  surpassed.  An  Irish 
girl  has  spun  linen  yarn  of  which  a  pound  was  1,432 
English  miles  in  length,  and  of  which,  consequently, 
17  Ibs.  13  ounces  would  have  girt  the  globe  ;  a  dis 
tinctly  visible  portion  of  such  thread  could  not  have 
weighed  more  than  ^7/oso,m  of  a  grain.  Cotton  has  been 
spun  so  that  a  pound  of  thread  was  203,000  yards  in 
length,  and  wool  168  yards.  And  yet  these,  so  far  from 
being  ultimate  particles  of  matter,  must  have  contain 
ed  more  than  one  vegetable  or  animal  fibre  ;  that 
fibre  being  of  itself  of  complex  organization,  and  built 
up  of  an  indefinitely  great  number  of  more  simple 
forms  of  matter. 

"  The  microscope  has,  however,  revealed  to  us  still 
greater  wonders  as  to  the  degree  of  minuteness  which 
even  complex  bodies  are  capable  of  possessing.  Each 
new  improvement  in  our  instruments  displays  to  us 
new  races  of  animals,  too  minute  to  be  observed  be 
fore,  and  of  which  it  would  require  the  heaping  toge 
ther  of  millions  upon  millions  to  be  visible  to  the  naked 
eye.  And  yet  these  animals  live  and  feed,  and  have 
their  organs  for  locomotion  and  prehension,  their  ap 
petites  to  gratify,  their  dangers  to  avoid.  They  possess 


ATTENUATIONS    OF    DRUGS,    ETC.  Ill 

circulating  systems  often  highly  complex,  and  blood, 
with  globules  bearing  to  them,  by  analogy,  the  same 
proportion  in  size,  that  our  blood  globules  do  to  us  ; 
and  yet  these  globules,  themselves  organized,  possessed 
of  definite  structure,  lead  us  merely  to  a  point  where 
all  power  of  distinct  conception  ceases  ;  where  we 
discover  that  nothing  is  great  or  small  but  by  com 
parison  ;  and  that  presented  by  nature  on  the  one  hand 
with  magnitudes  infinitely  great,  and  on  the  other  with 
as  inconceivable  minuteness,  it  only  remains  to  bow 
down  before  the  omnipotence  of  Nature's  Lord,  and 
own  our  inability  to  understand  him."  (Kane's  Chem 
istry,  by  Draper,  p.  19.) 


CHAPTER  X. 

ATTENUATIONS  OF  DRUGS   AND  REPETITIONS  OF  DOSES. 

In  selecting  our  attenuations  for  the  cure  of  disease, 
the  following  circumstances  are  to  be  taken  into  con 
sideration :  1,  the  age,  sex,  temperament,  constitution, 
and  habits  of  life  ;  2,  the  condition  of  the  disordered 
textures  ;  3,  the  character  of  the  drug  to  be  employed. 

(a)  Age.  Infants  and  children  of  tender  years, 
whose  organisms  have  not  become  blunted  by  expo 
sure  to  the  ordinary  stimuli  of  life,  by  improper  food 
and  drinks,  and  by  abuse  of  cathartics  and  opiates, 
are  in  the  most  eminent  degree  impressible,  and  re 
quire  the  highest  attenuations.  It  is  at  this  period 
that  the  circulation  is  most  active,  the  nervous  system 
most  delicate,  and  the  tissues  most  sensitive  to  the 
influence  of  external  agencies. 

At  the  middle  poriod  of  life,  when  the  body  has  ar 
rived  at  maturity,  and  all  of  the  organs  have  acquired 
their  full  strength  and  vigour,  the  resisting  power 
against  both  medicinal  and  morbific  agencies  is  at  its 
maximum.  The  action  of  the  circulatory  vessels  is 
now  moderate  and  stable,  the  nerves  are  strong,  the 
structures  have  become  accustomed  to  all  kinds  of 


112  ATTENUATIONS    OF    DRUGS,    ETC. 

stimuli,  and  the  mind,  which  exercises  so  powerful  an 
influence  over  the  body,  acts  calmly  and  judiciously. 
At  this  period,  our  lower  attenuations  will  often  serve 
us  more  efficiently  than  the  higher. 

During  the  decline  of  life,  many  circumstances 
which  have  a  tendency  to  modify  the  operation  of 
medicines,  are  to  be  considered.  Individuals  who 
have  passed  their  lives  in  intemperance,  who  have 
been  afflicted  with  frequent  attacks  of  disease,  and 
whose  systems  are  loaded  with  the  cumulative  poi 
sons  of  drugs,  usually  acquire  a  remarkable  obtuse- 
ness  and  inactivity  of  the  whole  organism,  so  that  the 
very  lowest  attenuations  are  requisite  to  effect  suita 
ble  impressions.  On  the  other  hand,  many  old  peo 
ple,  upon  the  verge  of  second  childhood,  become 
sensitive,  irritable,  and  so  intensely  impressible,  that 
the  higher  preparations  respond  promptly  and  effect 
ively. 

(b)  Sex.    Females  are  more  easily  acted  upon  by 
medicines  than  males,  for  several  reasons.     Perhaps 
the  most  prominent  one  consists  in  their  superior  deli 
cacy  of  organization :  their  circulation  is  more  active, 
their  nervous  systems  more  irritable,  and  their  mental 
powers  more  acute  and  quick,  although  less  strong, 
logical   and   independent  than  those  of  men.     J.   J. 
Rousseau  asserts,  that  a  woman  will  leap  to  a  conclu 
sion   which   would   require    a   man    hours  of  severe 
thought  to  arrive  at.     It  is  this  susceptibility  and  de 
licacy  of  organization  which  render  the  female  more 
impressible   than   the    male   sex,   and  which   should 
always  have  no  inconsiderable  weight  in  the  selection 
of  attenuations. 

(c)  Temperament.    The   temperament  also   has  an 
important  influence   in  the   operation  of   medicines. 
As  most  morbific  and  remedial  agents  produce  their 
effects  upon  the  sentient  extremities  of  the  nerves,  it 
follows  that  a  highly  susceptible  condition  of  the  ner 
vous  system  is  most  favourable  to  the  prompt  opera 
tion  of  these  causes.     We  therefore   infer,  that  the 
higher  attenuations  are  better  adapted  to  the  nervous, 
than  to  either  of  the  other  temperaments. 

Next  to  the  nervous  temperament,  in  point  of  sus 
ceptibility,  may  be  ranked  the  sanguine.  Individuals 


ATTENUATIONS    OF    DRUGS,    ETC.  113 

of  this  temperament  are  characterized  by  great  ac 
tivity  and  energy,  and  by  prominent  development  and 
vigour  of  the  vascular  system. 

The  temperaments  which  are  the  least  susceptible 
to  remedial  impressions,  are  the  bilious  and  lymphatic. 
The  former  is  characterized  by  large  muscular  devel 
opments,  tendency  to  biliary  derangements,  frequent 
turns  of  melancholy,  and  great  powers  of  endurance. 
The  latter  is  distinguished  by  a  predominant  activity 
of  the  glandular  system,  by  a  flabby  and  relaxed  con 
dition  of  the  muscles,  and  by  a  feeble  and  rather  ob 
tuse  state  of  the  nervous  system.  These  tempera 
ments  sometimes  require  our  lowest  attenuations,  es 
pecially  in  chronic  diseases. 

Two  or  more  of  these  temperaments  often  unite  in 
the  same  person,  when  we  have  what  is  termed  a 
mixed  temperament.  This  variety  may  be  considered, 
upon  the  whole,  the  most  favourable  to  health  and 
longevity,  since  no  quality  predominates,  and  the 
functions  of  the  organism  are  more  equalized. 

(d)  Constitution,  Attenuations  must  also  be  se 
lected  with  a  due  regard  to  the  constitutional  pecu 
liarities  of  each  particular  case.  We  know  of  several 
persons  who  cannot  take  a  blue  pill,  or  a  pill  in 
which  calomel  is  a  constituent,  without  being  vio 
lently  salivated.  There  are  others  in  whom  opium 
produces  furious  and  protracted  delirium,  and  cathar 
sis,  as  primary  effects ;  others  cannot  carry  ipeca- 
cacuanha  about  their  persons,  or  inhale  the  smallest 
quantity  of  it,  without  attacks  of  asthma ;  others 
cannot  approach  the  rhus  plant  without  being  poi 
soned  ;  others  cannot  use  shell  fish,  and  certain  other 
sorts  of  food,  without  being  afflicted  with  urticaria ; 
the  smell  of  hay  causes  asthma  in  some,  and  the  de 
licate  fragrance  of  the  rose,  syncope,  in  others.  On 
the  other  hand,  there  are  some  organisms  which  can 
scarcely  be  impressed  with  even  large  and  continued 
doses  of  medicines.  Constitutions  which  have  been 
impaired  by  abuse  of  stimulants,  drugs,  tobacco,  and 
licentiousness,  and  in  which  there  is  an  abasement 
of  the  nervous  and  physical  power,  demand  low  at 
tenuations.  In  a  word,  it  will  be  found  on  rigid  exa 
mination,  that  each  individual  possesses  some  pecu- 


114  ATTENUATIONS    OF    DRUGS,    ETC. 

liarities  which  it  will  be  necessary  to  take  into  con 
sideration,  when  we  decide  respecting  the  strength  or 
repetition  of  a  remedy. 

(c)  Habits  of  life.  We  have  read  of  persons  who 
were  "  music  mad,"  but  we  have  often  seen  those  who 
were  medicine  mad.  The  world  is  full  of  this  class 
of  monomaniacs,  who  "  pass  away  their  time  in  des 
canting  on  their  own"  diseases,  and  in  filling  their 
bodies  with  all  sorts  of  injurious  and  nauseous  drugs. 
After  pursuing  this  course  a  long  time,  the  system,  by 
habit,  tolerates  enormous  quantities  of  the  poisons 
swallowed,  and  the  structures  lose,  in  a  measure, 
their  susceptibility  to  medicinal  impressions.  It  is 
for  this  reason  that  the  homo3Opathist  experiences  so 
much  difficulty  in  the  management  of  cases  of  dys 
pepsia,  hypochondria,  and  constipation,  which  have 
been  induced  by  long  continued  abuse  of  cathartics ; 
also  in  the  affections  of  confirmed  opium  eaters,  ha 
bitual  drunkards,  and  gourmands.  Individuals  of  these 
classes,  require  low  attenuations.  In  the  same  cate 
gory  may  be  ranked  those  operatives  who  make  a 
free  use  of  mercury,  the  salts  of  lead,  the  strong  acids, 
and  other  poisonous  substances  which  evaporate  at 
the  ordinary  temperature. 

Robust  persons,  who  pass  much  time  in  active 
exercise  in  the  open  air,  will  require  stronger  doses 
than  those  of  delicate  organization  and  of  studious 
and  sedentary  habits. 

2.  The  condition  of  the  disordered  textures.  Those 
parts  of  the  system  which  are  most  amply  supplied 
with  nerves,  are,  all  other  things  being  equal,  most 
susceptible  to  the  operation  of  medicines.  Thus  the 
eye  is  more  readily  impressed  than  the  arm  ;  the 
lungs,  stomach  and  intestines,  than  the  limbs  and 
joints,  &c.  Much,  also,  depends  upon  whether  the 
specific  employed,  is  positive  and  decided  in  its  ope 
ration. 

But  there  is  another  circumstance  of  vast  moment 
to  be  taken  into  consideration  in  the  choice  of  our 
attenuations,  and  to  which  we  have  elsewhere  called 
particular  attention.  We  refer  to  the  augmented  sus 
ceptibility  to  medicinal  impressions  which  inflamed 
structures  acquire.  We  have  shown  that  the  con- 


ATTENUATIONS    OF    DRUGS,  ETC.  115 

dition  of  inflamed  tissues  becomes  entirely  changed, 
and  that  their  acquired  susceptibilities  become  so 
morbidly  increased,  that  even  their  natural  stimuli 
cannot  be  tolerated,  but  when  allowed  to  operate,  be 
come  additional  and  powerful  sources  of  disease. 
The  natural  and  healthy  material  stimuli  of  the  eye, 
the  ear,  the  lungs,  the  stomach,  the  bladder,  &c.,  are 
grateful  during  the  normal  state  of  these  organs;  but 
let  inflammation  occur,  and  the  smallest  pencil  of 
light  becomes  intensely  painful  to  the  eye.  as  noises  to 
the  ear,  air  to  the  lungs,  food  and  drinks  to  the  sto 
mach,  and  urine  to  the  bladder. 

Nor  is  this  augmented  susceptibility  confined  to  the 
operation  of  the  natural  stimuli,  but  it  applies  with 
still  greater  force  to  the  action  of  specific  medicines, 
up  to  that  point  of  inflammatory  action  when  the  sen 
sitive  extremities  of  the  nerves  succumb  from  inten 
sity  of  excitement,  and  a  condition  bordering  on  pa 
ralysis  or  gangrene  obtains.  It  is  sometimes  difficult 
to  decide  when  this  morbid  erethism  has  arrived  at  its 
maximum,  and  the  atonic  state  commences ;  but  the 
gradual  subsidence  of  pain,  appearances  of  effusion 
or  ulceration,  and  diminished  sensibility  of  the  affect 
ed  part,  will  afford  us  the  best  indications  upon  this 
point.  This  fundamental  law  of  homoeopathy,  not 
only  serves  to  explain  in  the  clearest  possible  manner 
the  astonishing  effects  of  infinitesimal  doses,  but  it 
teaches  an  important  practical  fact,  at  present  un 
appreciated,  but  incontrovertible,  and  which  stands  at 
the  foundation  of  our  therapeutical  applications,  viz., 
to  ascend  in  our  scale  of  attenuations  in  proportion  to 
the  violence  of  the  inflammation,  until  we  arrive  at  that 
point  where  the  nerves  of  the  diseased  part  have  attained 
their  maximum  of  erethism,  after  which  we  must  again 
descend  the  scale  in  the  same  ratio. 

This  same  law  applies  with  equal  force  to  all  irri 
tations  of  the  nervous  system,  even  when  entirely  un 
attended  with  the  usual  phenomena  of  inflammation, 
redness,  swelling,  heat,  and  pain.  We  have  often 
seen  this  nervous  erethism  so  strongly  pronounced — 
and  where  there  were  no  signs  of  vascular  excite 
ment — that  a  single  grain  of  ipecacuanha,  or  the  twen 
tieth  part  of  a  grain  of  tartarized  antimony,  would 


ATTENUATION    OF    DRUGS,    ETC. 

produce  copious  vomiting  and  purging ;  or  a  drop  of 
the  first  dilution  of  nux  vomica,  induce  involuntary 
contractions  of  the  muscles,  especially  of  those  parts 
which  were  unusually  irritable  ;  or  a  single  grain  of 
jalap,  rheum,  calomel,  or  even  a  mental  emotion,  im 
mediately  cause  diarrhoea ;  or  a  cup  of  tea  or  coffee 
taken  in  tine  evening,  prevent  sleep  for  a  whole  night ; 
or  the  inhalation  of  a  few  imponderable  particles  of 
ipecacuanha,  give  rise  to  both  its  primary  and  second 
ary  specific  effects  upon  the  pulmonary  organs. 

There  may  be  a  few  apparent  exceptions  to  this 
rule,  as  in  the  example  already  referred  to  respecting 
the  inefficiency  of  large  quantities  of  opium  and  lau 
danum  in  tetanus ;  but  these  exceptions  are  suscep 
tible  of  ready  explanation.  In  this  disease  there  exists 
a  peculiar  preternatural  excitement  of  the  nerves, 
which  preside  over  the  voluntary  motions,  and  the 
contractility  of  the  tissues,  which  induces  a  spas 
modic  occlusion  of  those  textures  of  the  digestive  canal 
which,  in  the  normal  state,  permit  the  absorption  of 
opiates.  This  is  evident  from  the  fact,  that  if  lauda 
num  be  injected  into  the  veins  during  tetanus,  the  usual 
effects  are  manifested.  In  this  exception,  therefore, 
the  drug  is  not  absorbed,  and  of  course  cannot  exercise 
its  specific  effects  upon  the  economy. 

It  is  evident,  then,  that  in  the  selection  of  attenua 
tions  for  chronic  diseases,  the  precise  condition  of 
the  nerves  of  the  affected  parts  must  always  be  taken 
into  consideration,  since  some  chronic  maladies  are 
characterized  by  a  highly  exalted  nervous  suscepti 
bility,  and  call  for  the  use  of  high  attenuations  ;  while 
in  other  cases,  this  susceptibility  or  impressibility  re 
mains  at  a  low  grade,  and  consequently  will  only 
respond  to  low  attenuations. 

Dr.  Lobethal,  in  alluding  to  this  subject,  makes  use 
of  the  following  language: — "God  be  praised,  the 
times  are  passed  when  we  adhere  without  examina 
tion  to  the  prescriptions  of  Hahnemann,  and  when  we 
administered  the  thirtieth  dilation  in  every  case,  with 
out  any  regard  either  to  the  species  of  the  medicine,  or 
the  individuality  of  the  patient.  The  idea  of  greatness 
or  littleness  is  but  relative  ;  we  cannot  say  in  a  ge 
neral  manner,  that  some  drops  of  the  mother  tincture 


ATTENUATION    OF    DRUGS,    ETC.  117 

of  a  certain  medicine  will  be  a  strong  dose ;  nor  yet, 
perhaps,  that  the  twenty-fourth  or  thirtieth  dynami- 
zation  of  every  medicine  shall  be  regarded  as  a  feeble 
dose.  The  dose  of  each  medicine  should  be  strong- 
enough  to  provoke  the  necessary  reaction  of  the  organ 
ism,  and,  provided  we  are  careful  not  to  administer 
a  too  heavy  one.  agreeable  to  take,  and  without  dan 
ger,  we  should  always  give  a  sufficient  one. 

"  I  am  decidedly  convinced,  that  in  order  to  apply 
the  homoeopathic  treatment  with  success,  the  physician 
should  take  cognizance  of  the  whole  scale  at  his  dis 
posal,  from  the  actual  dose  of  the  old  school,  up  to  the 
highest  dilutions  of  which  any  medicine  is  suscep 
tible. 

"We  may  establish  it  as  a  principle,  that  the  admi 
nistration  of  large  or  small  doses  is  in  inverse  propor 
tion  to  the  richness  in  nerves  of  the  individual  organ 
ism,  and  the  species  of  diseased  organ  ;  that  is  to 
say,  the  more  the  sentient  sphere  of  the  organism,  in  a 
given  case,  shows  itself  predominant,  the  more  the 
dose  of  the  indicated  specific  medicine  should  be 
feeble,  and  that  the  more  the  individual  organism,  or, 
in  a  local  affection,  the  diseased  organ,  is  poor  in 
nerves,  the  more  the  doses  should  be  large." — (Revue 
Critique  et  Retrospective  de  la  Matiere  Medicate  Spe- 
cifique.  Vol.  iii.,  1841). 

Dr.  G.  H.  Gross,  of  Germany,  also  observes,  that 
11  homoeopathia,  as  now  accepted,  has  determined  the 
point,  that  the  physician  must  exercise  his  judgment  as 
to  the  dose,  varying  it  from  the  HIGHEST  DILUTION  down 

tO     ONE    OR    MORE    DROPS    OF    THE    UNDILUTED    TINCTURE,     ttS 

individual  cases  may  demand."  * 

"In  the  Vienna  Homoeopathic  Hospital,  where  a 
chronic  case  is  rarely  seen,  the  dilutions  usually  given 
by  Dr.  Fleischmann,  range  from  the  first  to  the  sixth 
of  the  decimal  scale.  At  the  Linz  Hospital,  Dr.  Reiss, 
though  convinced  of  the  efficacy  of  the  highest  dilu 
tions,  and  occasionally  prescribing  them,  treats  the 
majority  of  his  patients  with  the  same  dilutions  as 
those  employed  by  Fleischmann.  In  looking  over  the 

*  Dr.  Gross  wrote  this  in  1840  ;  but  during  several  years  preceding  his 
death,  he  was  a  most  decided  advocate  of  the  highest  dilutions. 


118  ATTENUATION    OF    DRUGS,    ETC. 

records  of  homoeopathic  practice,  we  cannot  help  per 
ceiving  that  of  late  years  there  has  been  a  constant 
downward  tendency  with  respect  to  the  dilutions  (the 
high  potency  novelty  being  left  out  of  view).  Not 
only  is  this  true  with  respect  to  the  generality  of 
cases  recorded,  but  also  with  respect  to  the  practice 
of  individuals.  The  majority  of  those  statistics  to 
which  we  so  triumphantly  appeal,  are  undoubtedly 
derived  from  the  employment  of  the  lower  dilutions." 
(British  Jour,  of  Horn.  No.  xxiii,  p.  25,) 

Dr.  E.  F.  Ruckert,  of  Germany,  also  \vrites  as  fol 
lows  :  "  I  am  satisfied  that  the  system  (homoeopathia) 
is  still  progressive,  and  has  by  no  means  attained  its 
perfection.  In  respect  to  doses,  most  generally,  I  make 
use  of  the  first  dilutions,  and  never  exceed  the  twelfth, 
giving  them  in  increased  volume  and  repeating  them 
frequently.  I  have  been  more  successful  in  this  course 
of  treatment  than  formerlv  in  the  use  of  the  smaller 
doses." 

Similar  views  have  recently  been  promulgated  upon 
this  subject,  by  G.  Schmid,  Trinks,  Griesselich,  Watzke, 
Madden,  Bigel,  Drysdale,  Russell,  and  indeed  by  a  ma 
jority  of  our  school,  both  in  Europe  and  America. 

We  have  not  unfrequently  been  able  to  cure  disease 
with  a  high  attenuation,  after  having  failed  with  the 
first  and  second  dilutions  of  the  same  remedy  ;  but  it 
has  been  a  much  more  common  occurrence  with  us,  to 
effect  cures  with  the  first  attenuation  after  having 
been  unsuccessful  with  the  higher  preparations.  No 
definite  rules,  therefore,  can  be  given  which  will  apply 
in  all  cases,  but  every  circumstance  connected  with 
each  particular  case  must  be  duly  investigated,  and 
the  physician  then  exercise  his  own  best  judgment. 

3.  The  character  of  the  medicine  to  be  employed. — Cer 
tain  substances  which  are  very  feeble  or  even  inert, 
in  their  natural  crude  state,  appear  to  acquire  new 
and  potent  qualities  on  trituration.  Whether  these 
new  properties  are  communicated  to  the  minutely  di 
vided  particles  by  a  chemical  combination  with  the 
oxygen  of  the  air,  for  which  several,  like  carbon,  gra 
phite,  sulphur,  lime,  &c.,  possess  a  very  strong  affin 
ity,  or  whether  they  arise  from  the  simple  subdivision 
of  the  atoms  of  the  drug,  we  are  unable  to  determine. 
But  these  are  thft  medicines  which  have  been  found 


ATTENUATION    OF   DRUGS,    ETC.  119 

especially  serviceable  when  employed  in  high  attenu 
ations. 

On  the  other  hand,  there  is  a  class  of  medicines 
so  volatile  in  their  nature,  that  trituration  and  expo 
sure  to  the  air  and  moisture,  deprive  them  of  their  ac 
tive  principles.  Amongst  these  articles  may  be  rank 
ed  camphor,  ammonia,  bromine,  nit.  argenti,  the 
ethers,  the  volatile  salts,  &c.  Medicines  of  this  kind 
should  always  be  exhibited  in  the  lower  attenuations. 

We  must  also  be  governed  somewhat  by  the  posi 
tive  or  negative  character  of  the  specific  employed. 
Some  medicines  are  very  marked  and  prompt  in  their 
specific  operation,liketartarized  antimony,  phosphorus, 
ipecacuanha,  belladonna,  aconite,  hyoscyamus,  stra 
monium,  opium,  &c.,  and  may  ordinarily  be  used  at 
rather  higher  attenuations  than  those  whose  primary 
effects  are  less  prompt  and  strongly  pronounced. 

The  advantages  which  we  obtain  from  a  minute 
subdivision  of  crude  substances,  are  as  follows: 

1st.  We  develop  every  part  of  the  active  principle- 
pertaining  to  the  substance,  by  breaking  up  all  natu 
ral  organization  or  arrangement  between  its  molecules, 
and  thus  exposing  a  large  amount  of  active  surface 
which  would  otherwise  have  remained  latent. 

2d.  By  distributing  these  molecules  intimately 
throughout  an  inert  vehicle,  (sugar  or  water,)  they  are 
far  more  readily  absorbed  by  the  delicate  lacteals  and 
absorbents,  than  coarse  and  irritating  particles  of  mat 
ter. 

3d.  When  these  minute  atoms  have  been  conveyed 
by  the  blood  to  those  parts  with  which  they  have  an 
affinity,  they  penetrate  the  smallest  vessels,  impress 
the  minutest  sentient  nerves,  and  become  productive 
of  results  entirely  unattainable  by  drugs  in  a  crude 
form. 

4th.  During  the  act  of  subdivision,  it  is  not  impro 
bable  that  the  atoms  of  drugs  sometimes  become  oxy- 
dized,  and  thus  acquire  new  and  increased  powers. 

Finally,  we  infer,  that  no  new  properties  are  deve 
loped  by  the  homeopathic  method  of  preparing  drugs, 
except  such  as  arise  from  the  mere  subdivision  of  their 
particles  ;  and  that  all  ideas  respecting  spiritualization, 
dynamizaiion,  and  magnetism,  in  the  preparation  of 
medicines,  are  erronpons  and  untenable. 


120  ATTENUATION     OF    DRUGS,    ETC. 

In  regard  to  the  repetition  of  doses,  we  are  to  be 
guided  by  the  acute  or  chronic  nature  of  the  malady, 
the  urgency  and  danger  of  the  symptoms,  and  the  ef 
fects  produced  by  the  medicine. 

In  violent  and  dangerous  acute  diseases,  like  cholera- 
asphyxia,  convulsions,  phrenitis,  pleuritis,  gastritis, 
&c.,  the  remedies  should  be  repeated  as  often  as 
every  fifteen,  twenty,  or  thirty  minutes — until  an  ag 
gravation  of  the  symptoms,  (that  is,  some  primary 
effect  of  the  drug),  appears,  or  a  perceptible  ameliora 
tion  of  the  symptoms  is  apparent,  when  the  medicine 
should  be  omitted,  in  the  first  case,  until  the  secondary 
or  curative  symptoms  have  come  on,  and  expended 
themselves  ;  and  in  the  latter,  so  long  as  amendment 
continues.  If  the  case  demands  it,  recourse  may  again 
be  had  to  the  same  medicine  ;  or  if  new  symptoms 
have  made  their  appearance,  another  appropriate 
remedy  may  be  selected. 

In  less  urgent  cases  of  acute  disease,  it  will  be  suf 
ficient  to  repeat  the  remedy  every  four,  six,  or  eight 
hours,  until  primary  symptoms  (aggravation)  occur, 
or  amelioration  of  the  symptoms  evinces  the  secondary 
or  curative  effects,  when  we  may  rest  tranquil  until 
the  amendment  ceases,  and  the  medicine  has  expended 
its  curative  effect. 

In  chronic  maladies,  the  remedy  may  be  repeated 
once  in  twelve  or  twenty-four  hours,  until  an  impres 
sion  is  perceptible,  either  in  the  form  of  primary  drug 
symptoms,  or  of  amelioration  of  the  morbid  condition. 
When  this  result  obtains,  we  may  with  great  propriety 
wait  until  the  full  effects  of  the  medicine  have  sub 
sided,  before  we  repeat  the  dose.  In  these  cases  it  is 
far  better  to  make  use  "of  doses  sufficiently  strong,  and 
repeat  them  sufficiently  often  to  induce  decided  pri 
mary  medicinal  symptoms — even  if  we  are  obliged  now 
and  then  to  give  antidotes — rather  than  to  remain  for 
weeks  in  doubt  as  to  whether  a  suitable  impression 
has  been  produced  by  a  single  dose.  It  is  very  rare 
that  moderate  drug  symptoms  are  productive  of  un 
pleasant  consequences  in  chronic  diseases,  while  the 
reaction  thus  induced  in  the  diseased  tissue,  usually 
has  the  effect  to  bring  about  a  much  more  speedy  cure. 
Indeed,  we  believe  it  may  be  set  down  as  a 


ATTENUATION    OF    DRUGS,    ETC.  121 

rule,  that  the  sooner  we  can  produce  a  moderate,  but 
decided  medicinal  action  in  a  structure  suffering  from 
chronic  inflammation,  the  sooner  will  a  curative  reac 
tion  follow,  and  health  result. 

"  It  would  therefore  appear  that  experience  has  con 
firmed  the  opinion  of  Hahnemann,  that  a  certain 
amount  of  aggravation  is  essential  to  the  therapeutic 
process  ;  in  the  vast  majority  of  cases  this  does  not 
make  itself  known  in  any  perceptible  degree,  but  it 
does  occur  in  a  certain,  though  small  amount  of  cases, 
sufficient  to  confirm  its  existence  as  an  essential  phe 
nomenon.  The  cases  in  which  it  occurs  with  infini 
tesimal  doses  are  probably  only  those  of  excessive  or 
even  idiosyncratic  susceptibility,  and  even  with  these 
it  is  a  phenomenon  of  no  danger,  and  only  slight  incon 
venience.  Hence  we  may  conclude,  that  a  normal 
dose  of  homoeopathic  medicines,  sufficiently  small  to 
avoid  the  liability  to  aggravation  in  a  certain  amount 
of  cases,  and  yet  sufficient  to  cure  best  and  quickest  in 
the  majority  of  cases,  is  a  mere  chimera,  and  ought 
not  to  be  sought  for  ;  but  in  seeking  for  doses  the  best 
for  the  majority  of  cases,  we  must  lay  our  account  for 
meeting  with  a  certain  number  of  aggravations,  but 
practically  these  latter  are  of  no  importance. 

Likewise  in  the  case  of  collateral  symptoms,  it  is 
affirmed  by  Hahnemann,  that  "  we  cannot  arrange  our 
doses  so  as  to  escape  the  liability  to  them  in  a  small 
and  practically  unimportant  degree." — (Dr.  Brysdale : 
British  Jour,  of  Horn.,  No.  xxiii.,  p.  22.) 

In  all  cases  of  urgent  acute  disease,  in  which  we  can 
find  no  single  remedy  which  corresponds  to  the  promi 
nent  symptoms,  it  is  necessary  to  select  a  second  reme 
dy  which  shall  cover  the  remaining  symptoms,  and  ad 
minister  it  in  alternation  with  the  first.  Pneumonia 
is  often  accompanied  by  cereirtf/inflammation  ;  typhus 
fever,  with  serious  disorder  of  the  intestinal  canal,  the 
lungs,  the  brain  and  nervous  system ;  intermittent 
fever,  with  enlargement  of  the  liver,  jaundice,  cough, 
&c. ;  and  other  maladies  with  affections  in  other  parts 
of  the  body,  which  are  not  strictly  connected  with  the 
original  complaint.  In  examples  of  this  kind,  the  al 
ternation  of  remedies  is  both  proper  and  necessary  ;  at 
the  same  time  it  must  be  remembered,  that  it  is  far 


122  GENERAL    DIAGNOSIS. 

more  desirable  that  a  single  medicine  should  be  chosen 
which  covers  all  the  symptoms  of  the  disease. 

The  same  rule  holds  good  with  respect  to  giving 
medicines  in  succession.  Whenever  the  first  remedy 
fails  in  producing  the  required  impression,  or  whenever 
important  new  symptoms  arise  to  which  the  original 
drug  does  not  correspond,  we  may  resort  to  another 
which  accords  with  the  totality  of  the  symptoms. 

A  large  proportion  of  homoeopathic  physicians,  both 
of  Europe  and  America,  now  advocate  a  frequent  re 
petition  of  doses  in  acute  diseases,  and  in  many  in 
stances  give  alternations  of  the  remedies.  Some  of 
those  who  have  expressed  themselves  decidedly  upon 
this  point,  are,  Drs.  Gross,  Schmid,  Rau,  Fleischmann, 
Reiss,Ruckert,Lobethal,  Hartmann,Russel,  Hull,Neid- 
hard,  Gray,  Currie,  Trinks,  Griesselich,  Madden,  Dud 
geon,  and  Quin. 

The  erroneous  ideas  which  were  formerly  enter 
tained  respecting  the  alternate  employment  of  reme 
dies,  are  at  present  nearly  abandoned.  So  long  as  the 
absurdity  prevailed  that  our  medicines  operated  in  a 
kind  of  spiritual  manner,  upon  certain  mysterious  ap 
pendages  of  the  organism,  termed  "  vital  properties" 
it  was  deemed  unsafe  to  administer  two  remedies  in 
alternation,  for  fear  of  creating  confusion  among  these 
dynamic  influences  ;  but  since  the  laws  of  absorption, 
and  the  specific  topical  action  of  drugs,  have  become 
so  fully  established,  there  is  no  longer  hesitation  in 
alternating  medicines  whenever  symptoms  appear  to 
require  it. 


CHAPTER  XL 

GENERAL     DIAGNOSIS. 

IT  is  a  matter  of  the  highest  importance  that  the 
homoBopath  should  be  perfectly  familiar  with  the  most 
approved  methods  of  diagnosis,  in  order  that  he  may 
take  advantage  of  every  possible  circumstance  which 
may  facilitate  his  investigations  of  disease.  Although 


GENERAL    DIAGNOSIS.  123 

a  patient  may  be  competent  in  general  to  indicate  the 
exact  seat  of  his  pain,  and  thus  enable  the  physician 
to  determine  what  organ  or  tissue  is  affected,  this  is 
by  no  means  true  in  all  cases. 

There  are  many  maladies  which  are  entirely  unat 
tended  with  pain,  or  any  other  local  sign,  by  which 
the  physician  can  detect  the  suffering  organ.  In  cases 
of  infants  and  young  children,  who  are  unable  to  indi 
cate  the  locality  of  their  sufferings,  and  in  some 
chronic  affections,  a  knowledge  of  the  external  signs 
is  of  vast  importance.  In  all  such  cases  a  proper  skill 
in  diagnosis  will  prepare  the  medical  man  to  pene 
trate  the  innnermost  recesses  of  the  organism,  and  to 
understand  its  most  profound  secrets. 

It  is  a  singular  and  highly  interesting  fact,  that  the 
pains  of  the  different  parts  of  the  body  impart  to  the 
countenance  certain  characteristic  and  easily  under 
stood  expressions.  As  these  signs  are  involuntary, 
and  almost  uniformly  present,  all  will  recognise  their 
importance  as  diagnostic  phenomena, 

In  forming  our  diagnosis,  it  is  essential  in  the  first 
instance  to  notice  accurately  every  circumstance  con 
nected  with  the  patient  which  is  at  all  peculiar  or 
unnatural.  The  general  expression  of  countenance, 
the  tone  of  voice  and  manner  of  speaking,  the 
figure,  attitude,  movements,  etc.,  should  be  attentively 
marked.  At  the  same  time,  age,  sex,  temperament, 
hereditary  predisposition,  occupation,  habits  of  life, 
whether  labouring  under  the  effects  of  any  previous 
malady  or  of  mercury,  and  whether  accustomed  to  the 
constant  use  of  opium,  should  all  be  duly  considered. 

The  patient  should  then  be  permitted  to  detail  his 
symptoms  after  the  manner  pointed  out  by  Hahnemann, 
in  his  Organon,  (pages  126-7).  In  cases  of  inability  on 
the  part  of  the  patient  to  enter  into  a  description  of 
the  case,  the  friends  should  be  called  upon  to  give  all 
of  the  information  in  their  power,  in  regard  to  the  rise 
and  progress  of  the  disorder.  An  attentive  perusal  of 
Hahnemann's  advice  upon  this  subject,  is  of  the  ut 
most  importance  to  the  acquisition  of  a  perfect  por 
traiture  of  every  complaint. 

Since,  however,  there  are  some  instances  in  which 
neither  the  patient  nor  friends  are  able  to  afford  any 


124  GENERAL    DIAGNOSIS. 

information  respecting  the  nature  or  seat  of  the  affec 
tion,  it  is  indispensable  to  acquire  a  knowledge  of  all 
external  and  involuntary  signs  which  can  in  any  way 
illustrate  the  character  of  the  malady. 

Allopathic  writers  have  divided  diagnostic  signs 
into  those  exhibited  by  the  countenance  ;  the  attitude  ; 
the  nervous  system ;  the  digestive  organs ;  the  circu 
latory  system, ;  the  respiratory  organs ;  the  skin  ;  the 
lymphatic  system  ;  the  secretions. 

As  the  countenance  is  an  excellent  index  of  what  is 
occurring  in  distant  parts  of  the  organism,  we  should 
note  attentively  the  expression  of  the  eyes,  nose, 
mouth,  and  forehead,  and  also  whether  sadness,  mo- 
roseness,  peevishness,  despair,  fear,  grief,  or  joy,  is 
evinced.  By  heeding  carefully  these  indications,  we 
shall  be  greatly  assisted  toward  accurate  opinions  in 
obscure  and  complicated  cases. 

Thus,  contraction  of  the  features,  rapid  dilatation 
and  contraction  of  the  nostrils,  dyspnoea,  with  expres 
sion  of  anxiety,  indicate  acute  inflammation  of  the  re 
spiratory  organs. 

Sharp  features,  and  expression  of  anguish,  "  fore 
head  wrinkled,  brows  knit,"  eyes  sunken,  counte 
nance  pale,  hollow  cheeks,  lips  dry  and  bluish,  indi 
cate  pain  and  severe  inflammation  of  the  abdominal 
viscera. 

General  expression  of  countenance  flushed  and  ex 
cited,  or  dull  and  stupid ;  eyes  red  and  brilliant,  or 
dull  and  heavy  ;  pupils  contracted  or  dilated ;  pro 
trusion  of  the  eyes,  with  a  wild  expression  ;  mouth 
drawn  to  one  side  ;  twitchings  of  the  eyelids  and 
muscles  of  the  face,  indicate  inflammation  of  the  cere 
bral  organs. 

Expression  anxious ;  respiration  difficult  and  rapid 
during  inspiration,  while  expiration  is  comparatively 
easy ;  symptoms  worse  after  assuming  the  recumbent 
posture;  face  swollen  and  livid;  indicate  hydrothorax. 

Face  flushed  and  swollen  ;  lips  blue  ;  eyes  promi 
nent  and  unnatural ;  face  cold  ;  sudden  startings  in 
sleep  ;  anxious  expression  ;  indicate  organic  disease  of 
the  heart. 

Cheeks  pale  and  blanched ;  lips  white,  and  puffy  ;  a 


GENERAL    DIAGNOSIS.  125 

dark  circle  around  the  eye-lids  ;  expression  of  languor 
and  debility,  indicate  chlorosis. 

Paleness  and  puffiness  of  the  upper  lip  indicate 
scrofula  and  verminous  affections. 

"  Eyes  and  face  red  ;  rapid  respiration  ;  motions  of 
the  nostrils  rapid  ;"  indicate  simple  acute  fevers. 

FIGURE    AND    ATTITUDE. 

Before  alluding  to  the  different  attitudes  assumed 
by  the  body  during  disease,  as  diagnostic  signs,  we 
shall  take  the  liberty  of  digressing  for  a  moment,  in 
order  to  touch  upon  the  importance  of  a  proper  culti 
vation  of  the  physical  powers,  as  a  means  for  securing 
the  most  perfect  corporeal  development  and  sym 
metry. 

In  order  that  the  organs  may  perform  their  functions 
in  a  proper  manner,  it  is  absolutely  indispensable  that 
the  body  should  retain  its  normal  structure  and  shape, 
and  remain  unincumbered  by  any  artificial  appliances 
which  tend  to  impede  the  circulation  or  check  the 
free  action  of  the  muscles.  Unfortunately  for  man 
kind,  it  has  been  customary  both  in  barbarous  and 
civilized  countries,  to  distort  artificially  certain  parts 
of  the  body,  under  the  absurd  notion  that  they  were 
improving  upon  nature,  and  enhancing  the  beauty  of 
the  figure  which  the  Supreme  Architect  had  formed  in 
his  own  image. 

Amongst  the  savage  tribes  of  the  Rocky  Mountains, 
it  is  customary,  and  we  suppose  fashionable,  for  the 
natives  to  flatten  the  forehead  by  long- continued  arti 
ficial  pressure.  This  constitutes  the  ideal  of  savage 
beauty,  and  is  the  common  method  of  improving  up 
on  the  works  of  the  Creator. 

In  other  barbarous  countries  it  is  customary  to  slit 
the  ears  and  nose,  and  hang  from  them  large  quanti 
ties  of  tin,  brass,  and  other  cheap  ornaments.  This, 
with  the  requisite  amount  of  tattooing  and  painting, 
illustrates  their  notions  of  what  the  human  figure 
should  be. 

In  China,  the  semi-barbarous  inhabitants  compress 
the  feet  of  their  females,  from  birth,  in  such  a  manner 
as  to  prevent  their  growth  and  development ;  and  in 


126  GENERAL    DIAGNOSIS. 

this  abominable  distortion  consists  their  idea  of  female 
beauty.  This  is  the  Chinese  improvement  upon  na 
ture. 

The  Turks  cram  their  women  with  "pil/au"  after 
the  manner  of  stuffing  geese,  to  cause  enlargement  of 
the  liver,  for  "pate  defoi  gras" — that  they  may  be 
come  enormously  fleshy,  and  thus  present  to  the  ad 
miring  eyes  of  their  lords,  figures  of  uniform  dimen 
sions  in  all  directions.  This  is  the  Moslem's  style  of 
female  beauty. 

In  the  highly  civilized  countries  of  Europe  and 
America,  it  is  not  customary  to  make  use  of  artificial 
contrivances  to  flatten  the  head,  prevent  the  growth 
and  development  of  the  feet,  to  slit  the  ears  and  nose, 
or  cram  their  women ;  but,  through  the  instrumental 
ity  of  those  "  infernal  machines,5'  corsets  and  stays, 
the  sex  deem  it  indispensable,  in  order  to  be  genteel,  to 
compress  entirely  from  its  natural  shape  the  most  im 
portant  and  vital  part  of  the  organism.  These  un 
natural  efforts  at  distortion  are  usually  commenced  at 
an  early  period,  and  continued  with  perseverance, 
until  the  figure  has  lost  its  natural  symmetry,  the 
lungs  are  forced  upwards,  out  of  their  just  position, 
and  the  abdominal  viscera  made  to  accommodate 
themselves  in  the  new  situation  to  which  they  have 
been  reduced  by  art. 

The  civilized  females  of  the  present  day,  affect  to 
contemn  the  symmetrical  figures  which  the  Creator  ori 
ginally  formed,  and  which  the  ancient  sculptors  de 
lighted  to  represent  in  marble,  and  have  chosen  to 
"  improve"  on  these  old-fashioned  notions,  by  partially 
cutting  off  the  connection  between  the  upper  and  low 
er  parts  of  the  body  ;  thus  reducing  it  from  the  shape 
of  those  models  of  perfection,  the  Venus  di  Medici,  and 
the  Venus  of  Milo,  to  that  of  a  wasp  or  an  hour-glass. 
We  have  not  only  the  authority  of  the  ancients  in 
all  those  master-pieces  of  art  in  which  they  have  il 
lustrated  their  ideas  of  beauty,  but  the  greatest  of 
modern  sculptors,  our  illustrious  countryman,  Powers, 
in  a  MS.  letter  before  us,  declines  a  suggestion  that  his 
exquisite  statue  of  Eve  should  be  exhibited,  because 
his  sense  of  harmonious  proportion,  as  well  as  of 
physical  necessity,  compelled  him  to  present  the  moth- 


GENERAL    DIAGNOSIS.  127 

er  of  mankind  in  the  shape  which  the  Creator  approv 
ed  as  the  ultimate  product  and  most  perfect  fruit  of 
divine  intelligence  and  energy.  "E  ye,"  the  sculptor 
says,  with  satirical  humour,  "  is  an  old-fashioned  body, 
and  not  so  \vell  formed  and  attractive  as  are  her 
grand-daughters, — at  least  some  of  them.  She  wears 
her  hair  in  a  natural  and  most  primitive  manner, 
drawn  back  from  the  temples,  and  hanging  loose  be 
hind,  thus  exposing  those  very  ugly  features  in  women. 
Her  waist  is  quite  too  large  for  our  modern  notions  of 
beauty,  and  her  feet,  they  are  so  very  broad  and  large  ! 
And  did  ever  one  see  such  long  toes  !  they  have  never 
been  wedged  into  form  by  the  nice  and  pretty  little 
shoes  worn  by  her  lovely  descendants.  But  Eve  is 
very  stiff  and  unyielding  in  her  disposition  :  she  will  not 
allow  her  waist  to  be  reduced  by  bandaging,  because  she 
is  far  more  comfortable  as  she  z.v,  and  besides,  she  has 
some  regard  for  her  health,  which  might  suffer  from  such 
restraints  upon  her  lungs,  heart,  liver,  fyc.,  fyc.,  fyc.  I 
could  never  prevail  upon  her  to  wear  modern  shoes, 
for  she  dreads  corns,  which,  she  says,  are  neither  con 
venient  nor  ornamental.  But  some  allowance  ought' 
to  be  made  for  these  crude  notions  of  hers,--— founded 
as  they  are  in  the  prejudices  and  absurdities  of  primi 
tive  days.  Taking  all  these  things  into  consideration, 
I  think  it  best  that  she  should  not  be  exhibited,  as  it 
might  subject  me  to  censure,  and  severe  criticisms,  and 
these,  too,  without  pecuniary  reward." 

Singular  perversion  of  taste  !  wonderful  and  all- 
powerful  influence  of  fashion,  which  can  induce 
so  many  intelligent  beings  to  suffer  torture  like  sava 
ges,  for  the  purpose  of  distorting  their  bodies,  and 
bringing  them  into  those  artificial  shapes  which  civil 
ized  nations  denominate  genteel  and  graceful ! 

Suppose  a  fashionable  woman  should  apply  corsets 
and  stays  to  a  favourite  monkey,  or  a  pet  lap-dog,  and 
so  compress  its  body  out  of  shape,  would  not  the  at 
tempt  be  pronounced  heartless,  and  its  author,  perhaps, 
be  indicted  for  cruelty  to  animals  ?  but  when  the  same 
barbarity  is  perpetrated  upon  a  human  being,  it  is 
tolerated,  because  it  is  genteel  and  fashionable  ! 

Were  females  the  only  sufferers  from  these  cruel 
practices,  the  sin  would  not  be  so  great ;  but  their 


128  GENERAL    DIAGNOSIS. 

posterity  participates  deeply  in  the  consequences  which 
result  from  their  criminal  perversity.  The  flat  and  nar 
row  chests,  the  stooping  gaits,  and  the  pale  or  sallow 
faces  which  greet  us  at  every  step,  demonstrate  the 
extent  of  our  physical  degeneration. 

But  the  female  sex  are  not  alone  censurable.  Too 
great  a  proportion  of  the  men, — of  this  country  espe 
cially, — become  round-shouldered,  crooked,  and  de 
formed,  from  a  want  of  free  muscular  exercise,  and  too 
close  an  application  to  business,  in  constrained,  bent, 
and  unnatural  positions. 

Physical  education  in  latter  times,  has  been  quite 
overlooked.  Parents  have  commenced  sending  their 
children  to  school  in  infancy,  and  their  embryo  minds 
have  been  tasked  with  all  kinds  of  mental  exercise, 
while  their  physical  powers  have  been  suffered  to  lan 
guish  in  heated  and  ill- ventilated  rooms.  Thus  they 
have  grown  up  with  improved  minds,  but  feeble,  unde 
veloped,  and  perhaps  crooked,  or  mis-shaped  bodies. 

Let  it  ever  be  remembered,  that  the  mind  and  body 
exerciso  an  influence  upon  each  other,  and  if  wTe  would 
secure  10  the  former  its  highest  development,  we  must 
cultivate  and  perfect  the  latter.  In  this  respect  we 
may  with  advantage  go  back  to  antiquity,  and  copy 
after  Herodicus,  in  advancing  physical  education. 

But  to  return  to  our  subject:  As  in  health  the  at 
titude  is  erect,  and  those  positions  are  assumed  by  the 
body  and  limbs  which  indicate  muscular  strength,  so 
departures  from  the  normal  standard,  induce  corres 
ponding  alterations  in  the  position  and  appearance 
of  the  body. 

Thus,  tremors ;  position  upon  the  back,  with  a  con 
stant  disposition  to  sink  down  towards  the  foot  of  the 
bed,  indicate  extreme  muscular  debility. 

Distressing  dyspnosa,  and  sense  of  suffocation  when 
lying  down ;  constant  desire  to  assume  the  erect  pos 
ture  ;  general  agitation,  cough,  and  appearance  of 
anxiety,  indicate  hydrothorax. 

Common  position  upon  the  back  ;  rigidity  and  mor 
bid  involuntary  contractions  of  the  flexor  muscles, 
usually  of  the  upper  extremities,  indicate  softening 
of  the  brain. 

Position  upon  the  back.  "  with  the  knees  drawn  up  ; 


GENERAL    DIAGNOSIS.  129 

head  and  shoulders  a  little  elevated  ;  dread  of  motion, 
indicate  abdominal  inflammation  with  acute  pain. 

Position  upon  the  belly  ;  pressure  of  the  abdomen 
affording  relief  ;  and  very  restless,  indicate  spasmodic 
abdominal  pains. 

Rigidity,  and  involuntary  contraction  of  the  muscles 
of  the  neck,  back,  and  limbs,  indicate  inflammation  or 
irritation  of  the  spinal  cord. 

In  the  advanced  stages  of  acute  diseases,  position 
upon  the  back,  with  the  legs  drawn  up,  indicate  reten 
tion  of  urine. 

THE    TONGUE. 

Much  information  may  be  gained,  in  many  instances, 
from  an  examination  of  the  tongue.  The  following 
are  a  few  of  the  diagnostic  signs  presented  by  this  or 
gan: 

A  clean,  smooth,  and  bright  red  tongue,  indicate  in 
flammation  of  the  gastric  or  intestinal  mucous  membrane. 

A  clean  and  red  tongue,  with  papilla  prominent  ;  or 
a  furred  tongue,  with  red  papilla  appearing  through 
the  fur,  indicate  scarlatina. 

A  reddish,  and  tremulous  tongue,  indicates  mania  a 
potu. 

A  thick  and  yellow  fur  covering  the  tongue,  with 
bitter  taste,  indicate  biliary  derangement. 

A  white  fur  upon  the  tongue,  indicates  slight  simple 
fever. 

Acute  symptomatic  fevers,  effect  but  little  change  in 
the  appearance  of  the  tongue. 

A  relaxed,  dilated,  and  tremulous  tongue,  indicates 
congestive  or  nervous  fevers. 

A  pale  and  flabby  tongue,  "  with  large  papilla,"  in 
dicate  gastric  debility — met  with  in  chlorosis. 

A  sharp  and  pointed  tongue,  is  often  observed  in 
irritation  and  inflammation  of  the  brain. 

THE    NERVOUS    SYSTEM. 

Tearing,  throbbing,  and  aching  pains — aggravated 
by  contact,  pressure,  or  movement,  indicate  inflamma 
tory  action. 

Twitchings  of  the  limbs  ;  jerkingsand  shocks  of  the 
6* 


130  GENERAL    DIAGNOSIS. 

tendons  ;  cramps  ;  convulsive  movements ;  violent 
contortion  of  the  body  ;  pains  relieved  by  pressure ; 
unattended  with  fever,  indicate  spasmodic  pains. 

Sharp  and  darting  pains,  unaccompanied  by  swell 
ing,  heat,  or  redness,  indicate  neuralgic  pains. 

Vague  and  wandering  pains  about  the  ancle  often 
indicate  inflammation  of  the  knee. 

Pains  also  in  other  healthy  parts,  sometimes  indi 
cate  inflammations  in  remote  structures. 

Wakefulness,  indicates  irritation  of  the  nervous  sys 
tem. 

Irresistible  inclination  to  sleep,  with  stertorous 
breathing,  indicates  compression,  or  serious  disturb 
ance  of  the  brain. 

Twitching  of  the  muscles  during  sleep,  and  fre 
quent  waking  from  frightful  dreams,  indicate  organic 
disease  of  the  heart ;  also  characteristic  of  verminous 
irritation. 

Sudden,  rapid,  and  jerking  movements  of  the  head 
and  limbs,  indicate  cerebral  irritation,  mania  a  potu, 
and  some  forms  of  insanity. 

THE    ALIMENTARY    CANAL. 

The  alvine  discharges  will  afford  many  useful  hints 
to  the  observing  physician. 

Thus,  light  or  clay-coloured  evacuations  denote  a 
lack  of  bile. 

Mucous  and  bloody  stools  indicate  intestinal  inflam 
mation  :  if  accompanied  with  tenesmus,  and  redness 
or  protrusion  of  the  rectum,  we  may  conclude  that 
the  lower  part  of  the  canal  is  affected. 

Watery  stools,  with  slight  pain,  indicate  irritation 
of  the  bowels. 

"  Glairy,  dark  green  evacuations,  like  chopped  spin- 
age,  are  characteristic  of  hydrocephalus" 

Very  dry  and  hard  faeces  indicate  a  relaxed  and  tor 
pid  state  of  the  mucous  membrane  of  the  bowels. 

THE    RESPIRATORY    ORGANS. 

Using  the  abdominal  muscles  principally  in  respi 
ration,  indicates  inflammation  of  the  lungs. 

Using  the  intercostal  muscles  alone,  indicates  ab 
dominal  inflammation. 


GENERAL    DIAGNOSIS.  131 

Irregular  respiration,  with  stertorous  breathing,  in 
dicates  compression  of  the  brain. 

Inspiration  difficult,  anxious  and  rapid,  while  expi 
ration  is  comparatively  easy,  is  peculiar  to  hydrotho- 
rax. 

Wheezing,  short,  panting  and  anxious  respiration, 
with  contraction  of  the  larynx,  indicate  asthma. 

Paroxysms  of  rapid,  short,  suffocating  and  spasmodic 
cough,  indicate  pertussis. 

White,  tenacious  sputa,  indicate  chronic  bronchitis. 

Very  thick,  yellow,  or  greenish  sputa,  which  sinks 
in  water,  indicative  of  disorganization  of  the  lungs. 

THE    SKIN. 

A  yellow  skin  indicates  disordered  liver. 

A  sallow  skin  occurs  in  chlorosis,  and  a  few  chronic 
ills. 

A  pale  and  waxen  skin  denotes  a  deficiency  of  blood. 

A  blue  or  livid  skin,  in  infants,  indicates  a  pervious 
foramen  ovalc. 

A  hot  and  dry  skin  denote  inflammation. 

A  cold  skin,  with  internal  heat,  indicate  internal 
congestion. 

•  THE    URINE. 

Urine  red  and  scanty  denotes  inflammation. 

Urine  clear,  limpid,  and  abundant,  in  nervous  affec 
tions. 

Urine  depositing  a  sediment  indicates  biliary  de 
rangement. 

The  above  are  only  a  few  of  the  more  common  and 
well  known  diagnostic  signs.  Our  only  object  is  to 
direct  the  attention  of  physicians  to  this  subject,  for 
there  are  often  many  things  about  the  general  ap 
pearance  of  a  patient  which  are  slight  and  indescriba 
ble  in  themselves,  but  which  will  aid  him  materially 
in  forming  his  opinions. 

In  order,  then,  to  arrive  at  a  correct  diagnosis,  it  is 
necessary — 

1.  To  note  all  external  signs. 

2.  To    ascertain    the    age,    occupation,    previous 
habits,   predispositions,   and  peculiarities  of  the  pa~ 
tient 


132  FEVERS. 

3.  To  procure  from  the  patient  a  spontaneous  and 
minute  detail  of  his  sufferings  in  his  own  language. 
When  the  patient  is  unable  or  incompetent  to  afford 
this  information,  get  as  accurate  a  description  as  pos 
sible  from  those  best  acquainted  with  the  history  of 
the  case. 

4.  Ask  such  questions,  and  make  such  examinations 
by  the  touch,  pressure,  sight,  hearing,  percussion,  aus 
cultation,  &c.,  as  may  be   necessary  to  perfect  the 
diagnosis. 


CHAPTER  XH. 

FEVERS. 

Much  has  been  written,  and  many  hypotheses  have 
been  advanced,  from  time  to  time,  concerning  the 
pathology  of  this  important  class  of  diseases.  Within 
the  two  past  centuries,  the  changes  of  opinion  in 
regard  to  the  nature  and  seat  of  fevers,  have  been 
almost  innumerable  ;  and  yet.  with  all  that  has  been 
written,  and  the  numerous  bitter  controversies  wlych 
have  taken  place,  we  are  at  the  present  moment  but 
little  farther  advanced  as  to  any  definite  knowledge 
upon  the  subject,  than  we  were  centuries  ago.  Indeed, 
the  opinions  of  the  medical  world  at  the  present  time, 
are  so  much  at  variance,  that  it  would  not  be  difficult 
to  find  men  of  distinction  who  advocate  almost  everv 
doctrine  which  has  ever  been  promulgated. 

The  old  dogma  that  fevers  arise  from  a  concoction 
of  something  injurious  to  the  system,  has  even  its  ad 
vocates  ;  thus,  "  substances  in  a  state  of  putrefac 
tion,  by  entering  the  blood,  impart  their  peculiar  ac 
tion  to  the  constituents  of  that  fluid,  and  all  the  sub 
stances  of  the  body  are  induced  to  undergo  a  modified 
putrefaction"*  Again,  Dr.  Burne  says,  "  that  the  ady- 
namic  or  typhoid  fever  has  no  local  seat  ;  that  its  na 
ture  is  a  morbid  condition  of  the  blood,  produced  by  the 

*  Paris  Pharmacologia. 


FEVERS.  133 

operation  of  a  primary  cause,  the  respiration  of  a  con 
taminated  or  tainted  atmosphere." 

Dr.  Clancy  and  other  authors  believe  the  proximate 
cause  of  fevers  to  be  "  a  want  of  power  in  the  system 
to  form  blood." 

Others  still,  like  Clutterbuck  and  Broussais,  have 
contended  that  fevers  of  every  denomination  and  de 
gree,  are  the  result  of  inflammation.  They  are  sup 
posed  by  these  gentlemen  to  be  topical  affections,  "  the 
general  disorder  of  the  system  being  only  secondary 
and  sympathetic"  The  former  located  the  seat  of 
fevers  in  the  brain,  the  latter  in  the  gastro-intestinal 
mucous  membrane. 

The  vitalists  suppose  that  fevers,  in  common  with 
many  other  diseases,  are  owing  to  a  morbid  alteration 
of  what  are  termed  the  vital  properties  of  the  textures 
affected. 

Professor  Mackintosh,  of  Edinburg,  has  advanced 
the  opinion,  "  that  the  effects  of  outward  causes,  and 
inward  irritations,  in  producing  irregular  determina 
tions  of  blood,  are  the  great  agents  in  exciting  diseases, 
and  especially  fevers."  He  supposes  "  that  the  func 
tions  of  almost  all  organs  are  embarrassed  in  fever 
from  the  very  beginning  ;  that  internal  determinations 
of  blood  take  place,  which  rouses  the  system  to  reac 
tion,  and  thus  causes  fevers  ;  that  inflammations  of  all 
parts  of  the  body  will  give  rise  to  fever ;  that  inflam 
mation  may  supervene  during  fever,  without  being  the 
primary  cause  of  the  febrile  commotion ;  that  the 
nervous  system  is  involved  as  well  as  the  vascular ; 
and  that  the  blood  itself  must  be  in  a  diseased  cpndi- 
tion." 

A  majority  of  the  profession  at  the  present  day, 
however,  suppose  with  Cullen,  that  the  prime  causes 
which  produce  them,  act  directly  upon  the  nervous 
system,  and  thus  produce  their  pernicious  results. 

Our  own  opinion  is,  that  fever  is  a  combination  of 
symptoms  that  may  arise  from  a  disturbance  of  any 
one  or  more  parts  of  the  body  ;  that  the  primary  im 
pression  is  made  upon  the  extreme  nerves  of  the  part 
acted  on  ;  and  that  the  whole  system  is  affected  to  a 
greater  or  less  extent,  secondarily,  thus  giving  rise  to 
that  congeries  of  symptoms  which  constitute  fever. 


134 


FEVERS. 


The  skin,  the  nervous  system,  the  circulation,  the  res 
piration,  the  secretions,  and  indeed  the  whole  body 
partakes  more  or  less  in  the  general  disturbance. 

We  suppose  that  the  causes  which  produce  fevers, 
are  specific  -agents  which  operate  by  being  absorbed 
into  the  circulation,  and  (conveyed  to  those  structures 
for  which  they  have  an  affinity  or  attraction,  there  im 
parting  those  peculiar  and  specific  actions  which  in 
duce  fevers. 

The  miasm  which  causes  intermittent  fever  evi 
dently  impresses  a  different  part  of  the  organism  from 
that  which  induces  typhus.  So  also  the  miasms  of 
yellow  fever,  the  contagion  of  plague,  smallpox,  scar 
let  fever,  &c.,  are  all  peculiar  and  specific  morbific 
agents,  which  exercise  their  influences  upon  the  sys 
tem  in  different  ways  and  in  a  manner  analogous  to 
medicinal  agents.  Whether  this  morbific  influence  is 
exerted  upon  the  brain,  the  nervous  system,  the  blood, 
the  stomach,  or  the  arterial  coats,  of  one  thing  we  are 
quite  certain,  that  the  miasm  of  intermittent  fever  can 
never  cause  plague,  yellow,  scarlet,  or  typhus  fevers, 
nor  can  the  poison  of  either  of  these  maladies  give 
rise  to  any  disease  except  that  of  its  own  peculiar 
type. 

It  is  probable  that  the  contagion  arising  from  human 
effluvia — of  ship,  jail,  and  hospital  fevers,  scarlatina, 
smallpox,  plague,  and  the  different  kinds  of  malaria — 
are  all  distinct  substances,  composed  of  minute  parti 
cles  of  matter,  each  possessing  its  own  peculiar  proper 
ties,  and  each  exercising  its  own  specific  influence 
when  introduced  into  the  human  organism.  Unless 
this  were  true,  we  should  see  either  of  these  affections 
constantly  giving  rise  to  any  of  the  others  indiscrimi 
nately. 

In  a  perfectly  healthy  and  vigorous  state  of  the  sys 
tem,  neither  miasms  nor  contagious  matters  are  capa 
ble  of  producing  their  peculiar  effects,  and  they  may 
continue  to  circulate  harmlessly  in  the  blood  for 
months,  until  the  system  is  debilitated  from  some  cause 
and  thus  predisposed  to  their  influence,  or  until  their 
noxious  qualities  shall  have  been  neutralized  by  fre 
quent  contact  with  the  air  respired  at  the  lungs.  The 
fact  that  physicians  and  other  healthy  persons  so  often 


FEVERS.  135 

expose  themselves  with  impunity  to  all  of  the  noxious 
agents,  proves  conclusively  that  a  certain  state  of  pre 
paration  is  an  essential  condition  to  their  operation. 

At  present  the  pathology  of  fever  is  so  little  under 
stood,  that  all  opinions  respecting  its  nature  and  seat 
must  be,  to  a  considerable  extent,  vague  and  conjec 
tural.  In  treating  upon  the  different  forms  of  fever, 
therefore,  we  shall  adopt  the  classification  of  Mackin 
tosh,  on  account  of  its  simplicity  and  the  superior  fa 
cilities  it  affords  for  diagnosis.  The  following  is  the 
arrangement : 

1st.  Intermittent  fever. 

2d.  Remittent  or  yellow  fever  :  infantile  remittent. 
3d.  Continued   fever,  subdivided  into    four  orders, 
viz. : — 

Fever  from  functional  derangement. 
"       from  inflammation. 
"       from  congestion. 

A  mixed  form  of  fever  between  these  three  last,  but 
in  which  congestion  predominates,  commonly  denomi 
nated  typhus  or  synochus. 
4th.  Hectic  fever. 

5th.  Fevers  attended  with  eruptions,  subdivided  as 
follows  :  Scarlet  fever. 

Measles. 
Smallpox. 

"       "     modified. 
Chickenpox. 
Miliary  fever. 
Roseola. 
Urticaria. 
Erysipelas. 
6th.  The  plague. 

In  all  of  these  fevers  there  are  certain  peculiar 
characteristics  which  serve  to  distinguish  them  from 
each  other,  and  from  all  other  maladies.  Notwith 
standing  this,  however,  we  scarcely  ever  find  two 
cases  of  the  same  type  running  precisely  the  same 
course,  or  presenting  precisely  the  same  symptoms. 
So  many  circumstances  connected  with  the  exciting 
cause,  as  climate,  age,  sex,  temperament,  predisposi 
tions,  habits,  &c.,  tend  to  modify  the  character  of  each 
particular  case,  that  all  instances  of  the  same  malady 


136  FEVERS. 

must  necessarily  present  different  trains  of  symptoms. 
It  will  readily  be  perceived,  therefore,  how  impossi 
ble  it  is  to  prescribe  for  the  nftme  of  a  disease  instead 
of  symptoms.  We  also  take  this  occasion  to  express 
our  opinion,  that  any  classification  of  diseases  what 
ever,  is  valuable  as  an  aid  in  diagnosis  rather  than  in 
the  exhibition  of  remedies. 

The  course  of  a  fever  sometimes  varies  during  its 
progress  from  its  commencement  to  its  termination, 
and  on  this  account  divisions  are  made  into — 

1.  The  forming  stage. 

2.  The  cold  stage. 

3.  The  hot  stage. 

4.  The  sweating  stage. 

5.  Collapse. 

This  is  a  mere  arbitrary  division,  which  can  by  no 
means  be  relied  upon,  for  many  fevers  run  their  course 
without  the  supervention  of  these  stages.  Let  it  ever 
be  impressed  upon  the  mind,  then,  that  these  classifi 
cations  and  divisions  are  entirely  arbitrary  and  artifi 
cial,  and  can  only  be  used  for  the  purpose  of  facilita 
ting  our  diagnostic  examinations. 


CHAPTER  XIII. 

CAUSES  OF  FEVER 

The  causes  of  fever  are  either  predisposing  or  ex 
citing.  Anything  which  debilitates  the  organism,  or 
impairs  the  tone  and  resisting  power  of  the  nervous 
or  muscular  system,  maybe  denominated  a  predispo 
sing  cause  of  disease.  Under  this  head  may  be  ranked, 
excessive  physical  or  mental  exertion,  protracted 
grief,  anxiety,  fear,  chagrin  and  disappointment,  de 
privation  of  well  ventilated  dwellings,  proper  food, 
clothing  and  exercise,  over-indulgence  in  the  plea 
sures  of  the  table,  stimulating  drinks,  licentiousness, 
want  of  cleanliness,  and,  finally,  congenital  causes, 
and  those  connected  with  some  hereditary  predispo 
sition. 


CAUSES    OF    FEVER.  137 

Those  causes  which  induce  fever  by  a  direct  im 
pression,  are  termed  exciting  causes.  Miasmata, 
contagious  and  epidemic  effluvia,  noxious  gases,  ex 
treme  and  protracted  heat  or  cold,  and  sudden  changes 
of  temperature,  are  examples  of  this  class. 

All  of  the  causes,  however,  which  we  have  ranked 
under  the  head  of  predisposing,  may,  and  often  do  be 
come,  under  favourable  circumstances,  actual  exciting 
causes  of  fever. 

It  is  equally  true,  also,  as  we  have  before  observed, 
that  what  are  called  exciting  causes,  do  not  usually 
operate  so  as  to  produce  fever,  unless  the  system  is 
prepared  or  rendered  susceptible  to  their  influence  by 
debility,  or  some  other  predisposing  cause. 

The  powers  of  the  body  may  be  taxed  up  to  a  cer 
tain  point,  by  moral  or  physical,  morbific  or  remedial 
agencies,  without  exciting  actual  disease  ;  but  if  the 
influence  be  carried  beyond  this  point,  an  impaired 
condition  of  the  capillaries  acted  on  will  ensue,  with 
the  usual  concomitants,  inflammation  and  fever.  Even 
the  natural  maladies,  scarlet  fever,  measles,  smallpox, 
chickenpox,  and  hooping  cough,  seldom  make  their 
attacks  unless  the  system  is  predisposed  to  receive 
their  impressions.  Therefore,  these  disorders  will 
often  attack  one  member  of  a  family,  while  all  of  the 
rest,  who  are  equally  exposed  to  the  contagion,  will 
escape. 

The  same  rule  holds  good  in  regard  to  the  operation 
of  morbific,  as  of  remedial  agents,  viz. :  in  proportion 
to  the  departure  of  the  organs  and  tissues  from  their 
healthy  standard,  so  will  be  the  acquired  susceptibili 
ties  of  these  structures  to  the  influence  of  morbific 
agents. 

The  importance,  then,  of  a  constant  and  regular 
system  of  physical  culture,  and  a  rigid  avoidance  of 
all  those  things  which  can  in  any  way  impair  the 
normal  integrity  of  the  organism,  will  be  recognised. 
Indeed,  we  believe  that  such  a  course  might  be  pur 
sued,  as  would  secure  an  individual  against  disease 
until  his  system  should  succumb  from  old  age.  Such 
a  course  would  involve  a  herculean  task  in  our  pre 
sent  state  of  physical  degeneracy,  yet  it  is  not  beyond 
the  bounds  of  possibility. 


138  CAUSES    OF    FEVER. 

A  few  of  the  means  which  we  should  recommend 
to  accomplish  this  object  would  be, 

1st.  A  proper  system  of  physical  education. 

The  first  and  most  essential  condition  for  the  enjoy 
ment  of  perfect  health,  consists  in  a  symmetrical  and 
well  developed  organization.  In  looking  around  upon 
the  world,  how  few  do  we  behold  who  can  boast  of 
unexceptionable  physical  conformations — how  few 
who  have  not  some  imperfection  which  might  have 
been  avoided  by  an  early  and  proper  attention  to  phy 
sical  culture  ! 

But  how  shall  this  bodily  perfection  be  attained  ? 

We  reply,  by  the  universal  establishment  of  free 
public  gymnasiums,  where  those  athletic  exercises  can 
be  pursued  which  shall  systematically  develop  and 
strengthen  every  part  of  the  body.  We  repeat,  let 
there  be  established,  athletic  sports,  games,  &e.,  suita 
ble  for  all  ages  and  conditions  ;  where  the  man  of  ma 
ture  years  may  occupy  agreeably  an  occasional  leisure 
hour  with  physical  and  mental  benefit ;  where  the 
growing  youth  can  correct  all  incipient  bodily  defects, 
and  acquire  that  development  and  expansion  in  every 

Eart,  which  will  enable  all  of  the  organs  to  act  in  a 
*ee  and  healthy  manner.  Let  us  abolish  "  infant 
schools"  for  the  education  of  infant  intellects,  and  es 
tablish  in  their  place  infant  gymnasiums  for  the  culture 
of  their  infant  bodies.  Let  us  see  no  more  intellectual 
"  infant  prodigies,"  writh  their  pale,  sickly  faces,  and 
their  feeble  and  half-developed  forms,  but  show  us  in 
their  stead,  phijsical  prodigies  with  their  rosy  cheeks, 
their  plump,  firm,  and  well-grown  muscles,  and  with 
elasticity  and  buoyancy  reminding  us  constantly  of  per 
fect  health.  Show  us  your  children  of  six,  eight,  or  ten 
years  of  age,  wild,  bouncing,  and  overflowing  with  ani 
mal  spirits,  rather  than  your  prim,  well-mannered,  deli 
cate  sickly,  hot-house,  and  band-box  specimens. 

All  physiologists  agree  as  to  the  vast  importance  to 
the  young,  of  a  great  amount  of  exercise — free,  spon 
taneous,  and  unrestrained.  It  is  a  principle  of  their 
natures,  absolutely  essential  to  their  well-being,  and 
we  must  not  permit  the  artificial  customs  or  restraints 
of  society  to  prevent  it. 

Our  remarks  apply  with  more  force   to  cities  than 


CAUSES    OF    FEVER.  139 

to  the  country,  for  in  the  former  everything  is  forced 
and  unnatural :  children  are  born  into  hot-houses,  and 
reared  in  dwellings  heated  with  Lehigh  coal,  to  the 
temperature  of  75  or  80  degrees  Fahrenheit.  Here  do 
these  unfortunates  pass  the  best  part  of  their  existence, 
encompassed  by  everything  which  is  unnatural  and 
artificial,  and  inhaling  an  atmosphere  deprived  of  a 
portion  of  its  oxygen,  and  impregnated  with  carbonic 
and  other  noxious  gases,  until,  while  yet  young  in 
years,  they  arrive  at  the  conditions  of  old  age,  satiated 
with  the  displays  and  luxuries  of  life,  and  reduced  to 
a  miserable  state  of  physical  inefficiency. 

It  has  been  well  remarked  by  physiologists,  that  if 
the  large  cities  were  not  constantly  supplied  with 
healthy  recruits  from  the  country,  they  would  soon  be 
come  desert  wastes.  This  remark  is,  beyond  question, 
true,  and  it  is  only  necessary  to  look  into  any  of  our 
large  towns  and  behold  the  numerous  worn-out  and 
impotent  wrecks  of  the  wealthy  families  who  have 
been  inhabitants  for  two  or  three  generations,  to  be 
convinced  of  the  fact. 

The  second  means  which  we  should  advise  to  se 
cure  health  would  be,  a  correct  system  of  dietetics. 
The  use  of  all  kinds  of  animal  and  vegetable  sub 
stances  which  are  perfectly  pure,  digestible,  and 
healthy,  should  be  rigidly  prohibited.  In  order  to  ac 
complish  this  object,  we  do  not  believe  that  better 
rules  could  be  adopted,  than  those  instituted  and  com 
manded  by  Moses  for  the  Jews.  Amongst  the  articles 
forbidden  in  the  dietetic  regulations  of  the  great  He 
brew  lawgiver,  we  find  pork  excluded,  from  the  sup 
position  that  the  swine  is  unclean  and  unhealthy. 
When  we  consider  how  frequently  the  janimal  is  af 
fected  with  that  dreadful  malady,  scrofula,  and  also 
how  filthy  and  disgusting  are  its  habits,  it  is  not  sur 
prising  that  any  person  who  is  at  all  particular  as  to 
the  quality  of  the  food  he  consumes,  and  who  possesses 
ordinary  powers  of  observation,  should  denounce  this 
nasty,  offensive,  and  diseased  animal,  as  unfit  for  food. 
But  this  abominable  stuff  in  all  its  different  forms,  is 
consumed  by  Christians  everywhere*  Lard  constitutes 
the  culinary  expletive  which  serves  to  connect  the  in 
gredients  of  almost  every  dish  in  one  greasy  union. 


140  CAUSES    OF    FEVER. 

Whether  the  uses  of  pork  and  its  preparations,  have 
any  agency  in  causing  scrofula,  we  leave  for  others  to 
determine.  An  argument,  however,  which  tends  to 
establish  the  affirmative,  is  in  the  fact,  that  amongst  the 
strict  Jews,  and  all  of  those  nations  where  the  animal 
is  not  used  as  food,  this  malady  is  scarcely  known, 
while  in  every  country  where  it  constitutes  an  article 
of  diet,  scrofula  abounds. 

In  a  word,  care  in  regard  to  the  selection  of  proper 
articles  of  food,  suitable  methods  of  cookery,  avoidance 
of  fat  and  condiments,  stimulant,  narcotic,  and  hot 
drinks,  and  regularity  in  partaking  of  meals,  will  ena 
ble  mankind  to  preserve  the  integrity  and  health  of 
those  organs  which  are  concerned  in  digestion  and 
assimilation,  and  thus  avoid  the  numerous  evils  which 
accrue  from  errors  in  diet. 

Finally,  we  would  recommend  the  establishment  of 
such  a  state  of  society  as  should  recognise  no  pursuit 
or  custom  as  legal  or  respectable,  except  such  as  should 
conduce  directly  to  the  health,  morals,  and  general 
welfare  of  the  community. 

MIASMATA,    &C. 

Numerous  experiments  have  been  made  for  the  pur 
pose  of  arriving  at  the  chemical  and  physical  proper 
ties  of  miasmata,  and  contagious  and  epidemic  effluvia, 
but  as  yet,  all  investigations  upon  this  subject  have 
proved  futile.  We  only  know  that  wrhen  animal  or 
vegetable  substances  undergo  decomposition,  a  prin 
ciple  is  set  free  which  diffuses  itself  in  the  atmosphere, 
and  which  possesses  the  power  when  absorbed  into  the 
system,  of  producing  certain  specific  effects  upon  the 
extreme  nerves,  which  generate  fever.  The  portion 
which  is  thu*s  liberated  by  the  aid  of  heat  and  moisture, 
constitutes,  without  doubt,  the  active  principle  of  the 
original  crude  substance,  in  its  purest  form  and  most 
perfect  state  of  development.  This  active  principle  is 
as  imponderable  and  attenuated  as  the  preparations  of 
homoeopathy,  and  a  few  inhalations  under  favourable 
circumstances  are  capable  of  causing  fever  :  it  is  also 
as  specific  and  uniform  in  its  operation  and  effects  upon 
the  economy,  as  remedial  agents  themselves. 


141 


CHAPTER  XIV. 

INTERMITTENT  FEVER. 

We  have  observed  that  each  type  of  fever  is  marked 
by  certain  symptoms  which  distinguish  it  from  all 
other  varieties.  The  type  under  consideration  pre 
sents  its  characteristics  in  a  very  striking  manner. 
Indeed,  so  great  is  the  difference  between  intermittent 
and  other  fevers,  that  some  writers  have  withdrawn  it 
from  the  list  of  febrile  diseases,  and  ranked  it  with 
those  connected  with  derangement  of  the  cerebro- 
spinal  system.  The  regularity  and  distinctness  of  the 
paroxysms,  and  the  complete  state  of  apyrexia  between 
the  periods  of  attack,  certainly  offer  some  reason  for 
this  course  ;  but,  on  the  other  hand,  as  the  combina 
tion  of  symptoms  termed  fever,  is  universally  present 
during  the  paroxysms,  and  since  upon  the  whole  it 
bears  a  closer  resemblance  to  febrile  than  neuralgic, 
or  ganglionic  affections,  we  shall  continue  to  adopt  the 
old  classification. 

In  the  different  forms  of  intermittent  fever,  the  in 
terval  which  elapses  between  the  commencement  of 
one  paroxysm  and  another,  varies  ;  some  cases  hav 
ing  an  interval  of  24,  some  48,  and  others  72  hours 
from  one  attack  to  another.  From  this  circumstance 
the  different  types  have  been  designated — quotidian. 
or  V4  hour  type ;  tertian,  or  48  hour  type  ;  quartan,  or 
72  hour  type.  These  have  also  been  subdivided  into 
double  quartan,  double  tertian,  &c. 

DIAGNOSIS.  A  paroxysm  of  intermittent  fever  is 
composed  of  three  stages,  viz.:  first,  the  cold;  sec-* 
ond  the  hot  ;  third,  the  sweating  stages. 

Preceding  the  cold  stage,  there  usually  occur  gen 
eral  feelings  of  lassitude,  debility,  uneasiness,  and 
pains  in  the  head,  back,  or  loins,  and  sometimes  slight 
sensations  of  external  or  internal  cold.  There  is  also 
a  loss  of  appetite,  disinclination  to  bodily  or  mental 
exertion,  and  a  constant  disposition  to  stretch  or  yawn. 


142  INTERMITTENT    FEVER. 

As  the  cold  stage  actually  commences,  the  extremi 
ties  feel  cold  and  contracted  ;  the  surface  becomes 
pale,  shrunken,  rough,  with  diminished  sensibility;  a 
sensation  of  cold  along  the  spine,  extending  into  the 
thorax  and  abdomen  ;  the  coldness  soon  diffuses  itself 
throughout  the  whole  body  ;  universal  tremors,  exter 
nal  and  internal ;  chattering  of  the  teeth;  respiration 
laborious,  rapid,  and  imperfect  ;  oppression  at  the 
prsecordia ;  countenance  pale,  leaden,  earthy,  or  livid, 
shrunken,  and  expressive  of  anguish  ;  eyes  dull  and 
sunken ;  lips  livid  ;  general  sense  of  physical  and  men 
tal  prostration. 

The  pulse  is  variable  :  it  may  be  slow,  rapid,  weak, 
oppressed,  or  intermitting. 

The  temperature  of  the  body  is  usually  natural,  with 
the  exception  of  the  extremities. 

The  duration  of  this  stage  is  exceedingly  various  ; 
sometimes  terminating  in  ten  minutes,  at  other  times, 
lasting  four  or  five  hours. 

Paroxysms  occasionally  occur  without  any  well 
marked  cold  stage,  a  slight  trembling  only  being  ex 
perienced  previous  to  the  hot  stage ;  at  other  times 
neuralgic  or  rheumatic  pains,  or  coma,  precede  the 
second  stage. 

Hot  Stage.  As  soon  as  the  chills  begin  to  abate, 
flushes  of  heat  commence  passing  over  the  body,  until, 
in  a  short  time,  the  hot  stage  is  fully  developed. 

This  stage  is  characterized  by  hot  and  dry  skin  ; 
countenance  flushed  and  full ;  mouth  dry,  tongue 
parched ;  urgent  thirst ;  headache  ;  respiration  rapid 
and  anxious  ;  general  restlessness  ;  pains  in  different 
parts  of  the  body ;  more  or  less  disturbance  of  the 
mind;  pulse  usually  rapid,  sharp,  and  bounding. 

This  stage  also  varies  very  much  in  duration,  it 
rarely  terminating  in  less  than  four,  and  often  con 
tinuing  twelve,  and  sixteen  hours.  In  some  instances 
the  hot  stage  even  continues  several  days,  when  it  be 
comes  a  continued  fever ;  or  it  may  assume  the  remit 
tent  form. 

Sweating  Stage.  After  the  hot  stage  has  run  its 
course,  a  perspiration  makes  its  appearance  upon  the 
forehead  and  extremities,  which  is  soon  diffused  over 
the  whole  body.  As  the  sweating  becomes  more  and 


INTERMITTENT  FEVER.  143 

more  profuse,  the  febrile  symptoms,  with  the  pains  and 
uneasy  sensations,  gradually  subside,  until  the  parox 
ysm  terminates  in  a  perfect  state  of  apyrexia  or  con 
valescence. 

The  above  is  a  general  description  of  the  ordinary 
course  of  an  intermittent  paroxysm ;  but  in  some  in 
stances  these  stages  are  reversed,  or  one  or  more  of 
them  may  be  absent,  or  if  present,  only  a  few  of  the 
symptoms  enumerated  will  be  recognised. 

Writers  have  divided  intermittents  into  four  va 
rieties,  viz.,  first,  the  inflammatory ;  second,  the  con 
gestive  ;  third,  the  gastric  ;  fourth,  the  malignant  inter 
mittents. 

This  division  is  made  from  the  fact  that  the  differ 
ent  types,  under  certain  circumstances,  partake  of 
the  general  character  which  these  terms  indicate. 
Thus,  the  inflammatory  variety  generally  occurs  dur 
ing  the  winter  and  spring.  Quotidians  are  more 
prone  to  partake  of  this  modification  than  tertians  or 
quartans.  Patients  labouring  under  this  variety, 
rarely  enjoy  perfect  intermissions  between  the  parox 
ysms,  and  they  are  often  left  with  permanent  dis 
orders  of  the  liver,  lungs,  &c. 

The  congestive  variety  is  very  uncommon.  It  sel 
dom  attacks  any  except  those  of  feeble,  relaxed,  and 
exhausted  constitutions,  in  whom  there  is  not  suffi 
cient  vigour  to  accomplish  a  perfect  reaction.  The 
brain  is  the  organ  which  usually  suffers  most,  and 
coma  often  supervenes  during  the  cold  stage,  which 
ends  in  death. 

The  gastric  variety  presents  prominent  symptoms 
of  gastric  derangement  from  the  first,  a  superabun 
dance  of  the  biliary  secretion,  furred  and  bitter 
tongue,  with  nausea  and  vomiting.  It  is  peculiar  to 
temperate  latitudes,  and  usually  occurs  in  the  au 
tumn.  In  this  variety  the  liver  is  much  affected, 
and  therefore  we  find  chronic  enlargements  of  this 
organ  often  remaining  after  the  paroxysms  have  been 
subdued. 

The  malignant  intermittents  are  peculiar  to  hot  la 
titudes.  They  are  attended  with  extreme  debility 
from  the  onset ;  respiration  is  feebly  and  imperfectly 
performed,  the  blood  is  only  partially  oxygenated, 
diarrhosa  now  and  then  ensues,  and  a  rapid  prostra- 


144  INTERMITTENT   FEVER. 

tion  of  the  powers  of  the  system  usually  occurs,  which, 
in  many  instances,  speedily  proves  fatal. 

It  has  been  noticed  that  chronic  enlargements  and 
indurations  of  the  liver  and  spleen,  affections  of  the 
lungs,  dyspepsia,  scirrhous  indurations,  &c.,  often  suc 
ceed  fever  and  ague.  These  affections  have  been 
looked  upon  as  secondary  consequences  of  the  fever, 
while,  in  point  of  fact,  they  are  medicinal  diseases, 
superinduced  by  the  abuse  of  mercury  and  bark. 

These  drugs  are  empyrically  employed  by  the  allo 
path,  for  the  cure  of  this  malady  in  all  its  various 
forms:  Whether  inflammatory  symptoms  predomi 
nate,  whether  there  is  congestion  of  the  brain,  lungs, 
or  liver,  or  whether  the  system  is  exhausted  by  pre 
vious  debilitating  causes,  quinine  and  calomel  in  large 
doses  are  the  grand,  and  we  might  almost  say,  the 
only  remedies  of  allopathy.  But  do  these  violent 
drugs  actually  cure  the  malady  ?  When  the  parox 
ysms  are  arrested  by  the  use  of  these  herculean 
doses,  are  the  seeds  of  the  disease  eradicated,  and  is 
there  no  danger  of  a  relapse  ?  Let  the  candid  prac 
titioner  of  the  old  school  answer. 

It  is  the  opinion  even  of  some  eminent  allopaths, 
that  large  doses  of  quinine  often  suspend  chills 
and  fever,  by  superinducing  in  the  liver  or  some  other 
important  viscus,  a  serious  medicinal  inflammation  or 
congestion  which  usurps,  temporarily,  the  place  of 
the  intermittent.  The  effect  of  this  truly  allopathic 
measure  is,  however,  only  of  short  duration,  for  the 
paroxysms  return  again  as  soon  as  the  artificial  dis 
ease  has  somewhat  abated,  or  from  some  slight  ex 
citing  cause.  Thus  will  the  paroxysms  repeatedly 
return,  and  be  as  often  temporarily  suspended,  until 
finally  some  permanent  chronic  malady  will  become 
fastened  upon  the  system  and  thus  supersede  the  ori 
ginal  affection. 

Is  there  a  man  in  existence  sufficiently  robust  to 
swallow  with  impunity  the  quantities  of  antimony, 
calomel,  bark  and  quinine,  which  are  usually  pre 
scribed  by  the  old  school  in  fever  and  ague  ?  Must 
not  some  part  of  the  organism  necessarily  succumb 
before  such  formidable  quantities  of  powerful  medi 
cines  ?  Let  the  stoutest  allopath  presume  to  try  the 


INTERMITTENT    FEVER.  145 

experiment  upon  his  own  person,  and  if  he  escapes 
without  inflammation  of  the  stomach  and  intestines, 
serious  disease  of  the  liver,  lungs,  spleen,  or  some 
other  organ,  we  will  confess  our  error,  and  say  that 
large  doses  of  quinine  are  innocent  and  harmless,  and 
that  the  preparations  of  mercury  are  manageable, 
mild,  and  safe,  when  admitted  into  the  human  stom 
ach. 

Causes. — The  most  common  cause  of  intermittent  fever 
is  a  peculiar  miasm  which  arises  during  the  progress 
of  vegetable  decomposition,  and  which  some  authors 
have  termed  koino  miasmata.  The  term  marsh  miasm 
is  often  used,  but  we  deem  it  improper,  as  the  mi  asms 
generated  in  elevated  locations,  are  as  capable  of 
causing  the  disease,  as  those  formed  in  low  and 
marshy  ground.  The  decomposition  of  vegetable 
matters,  by  the  aid  of  solar  heat  and  moisture,  is  the 
only  condition  requisite  to  develop  the  morbific  prin 
ciple. 

Other  causes  occasionally  give  rise  to  fever  and 
ague,  as  intestinal  irritation  from  indigestible  food, 
and  worms,  sudden  suppression  of  old  discharges,  and 
atmospheric  vicissitudes. 

Therapeutics. — The  remedies  most  commonly  made 
use  of  in  this  malady,  are  china  and  arsenicum.  The 
following  will  also  be  found  appropriate  in  many  in 
stances  : — ipecacuanha,  bryonia,  eupatorium,  perfoli- 
atum,  nux  vomica,  veratrum  alb.,  belladonna,  carbo 
veg.,  pulsatilla,  antimonium  crud.,  ignatia,  cocculus,  la- 
chesisj  sabadilla,  sulphur,  cina,  natrum  mur.,  capsi 
cum. 

China. — External  indications. — Yellowish  colour  of 
the  skin  and  face  ;  during  the  chill  and  heat,  redness 
of  the  face,  and  distention  of  the  veins  of  the  face  and 
head.  "  During  the  chill,  bilious  vomiting ;  palpita 
tion  of  the  heart ;  short  cough." — (Hartlaub).  "  Du 
ring  the  intermission,  yellowish,  clay-coloured  counte 
nance  ;  weak  eyes ;  fulness  of  the  abdomen ;  cough ; 
anasarca.  In  tertian  fever,  with  thick,  brown,  yellow- 
coated  tongue :  countenance  palish  yellow  during 
the  paroxysm  and  intermission ;  swelling  in  the  re 
gion  of  the  spleen  ;  eyes  red  and  sensitive." — (Knorre.) 
Quotidian  fevers,  with  pale  countenance  :  cold  and 

7 


146  INTERMITTENT    FEVER. 

pale  hands  and  feet,  and  retching  np  of  mucus  during 
the  chill ;  while  during  the  fever  there  are,  red  face, 
full  quick  pulse,  dry  spasmodic  cough. 

Physical  Sensations. — Paroxysm  preceded  by  palpi 
tation  of  the  heart,  sneezing,  anguish,  nausea,  thirst, 
bulimia,  headache  and  colic.  Thirst  before  and  after 
the  shiverings,  or  during  the  sweating  stage  ;  coldness 
of  the  body,  with  congestion  to  the  head  ;  soreness  in 
the  region  of  the  liver  ;  easy  perspiration  during  sleep, 
or  when  moving  ;  short  cough  ;  for  the  most  part  no 
thirst  during  the  cold  or  hot  stages.  Hartlaub 
has  cured  chills,  external  or  internal,  without  thirst, 
followed  by  heat  with  thirst ;  and  followed,  or  not, 
by  sweat ;  or  chills  in  some  parts  of  the  body,  with 
shuddering  and  heat  in  the  head,  terminating  in 
fever,  intermingled  with  chill?,  attended  with  thirst 
and  followed  by  sweat ;  or  no  chills,  but  fever  with 
urgent  thirst,  and  afterwards  with  perspiration.  Hart- 
mann  advises  china,  when  we  have  during  the  pa 
roxysm  throbbing  pain  in  the  head,  extending  to 
the  orbits  ;  vertigo ;  nausea ;  pain  in  the  region  of 
the  liver  ;  sharp  pain  in  the  chest ;  short  cough ; 
aching  pain  in  the  abdomen  during  the  chill ;  pains 
in  the  loins  and  legs.  During  the  intermission,  confu 
sion  of  the  head  ;  transient  vertigo  ;  variable  appe 
tite  ;  thirst ;  drowsiness  after  meals  ;  uneasy  sensa 
tion  in  the  pit  of  the  stomach  ;  nausea  ;  constipation  ; 
general  debility.  Knorre  has  cured  the  quotidian 
type,  with  vertigo  ;  pale  and  cold  hands  and  feet, 
and  retching  of  mucus,  during  the  chill ;  and  pains 
in  the  head,  both  sides,  and  pit  of  the  stomach ;  dry 
and  jarring  cough,  and  drowsiness  during  the  fever, 
which  is  protracted  and  violent.  Also,  tertian  fevers, 
with  violent  chills,  heat,  and  thirst,  followed  by  per 
spiration.  During  the  paroxysm  and  intermission, 
there  were  bitter  taste,  eructations,  and  vomiting  ; 
aching  pains  in  the  pit  of  the  stomach,  and  in  the  re 
gion  of  the  spleen ;  yellow  and  sickly  aspect.  Also 
in  tertian  fever,  when  the  chill  is  short  and  slight,  but 
followed  by  violent  aching  pain  in  the  forehead,  in 
the  right  temple,  and  around  the  right  eye  ;  general 
heat ;  intense  thirst ;  eyes  hot,  painful,  and  sensitive 
to  the  light ;  paroxysm  commences  in  the  forenoon. 


INTERMITTENT    FEVER.  147 

lasts  until  evening,  and  is  succeeded  by  perspiration 
during  the  night. 

Mental  and  moral  symptoms. —  Confusion  of  ideas 
and  drowsiness  during  the  paroxysm  and  intermission  ; 
anxiety  ;  discouragement ;  great  activity  of  the  mind  ; 
sometimes  delirium. 

Administration. — One  drop  of  the  third  dilution  in  a 
teaspoonful  of  water,  may  be  given  previous  to  the 
chill,  and  during  the  forming  stage.  Should  this 
prove  insufficient  to  remove  the  symptoms,  the  dose 
may  be  repeated  every  four  hours  during  the  inter 
missions. 

Arsenicum. — External  indications. — Face  puffed  and 
earthy  ;  or  countenance  anxious,  sunken,  and  of  a  yel 
low  tint  ;  pendiculations  and  drawing  in  the  limbs 
during  the  cold  stage ;  pungent  and  burning  feel  of 
the  skin  during  the  fever  ;  dropsical  swellings  ;  trem 
bling  of  the  limbs  during  the  sweating  stage  ;  pulse 
irregular,  or  quick,  weak,  small,  and  frequent,  or  sup 
pressed  and  trembling ;  tongue  bluish,  white,  or 
bright  red ;  diminished  urine ;  night-sweats ;  face 
red  during  the  fever,  but  pale  and^unken  during  the 
intermission. 

Physical  sensations. — Aggravation  of  existing  symp 
toms  just  previous  to,  or  during  the  attack;  paroxysms 
imperfectly  developed  ;  chills  and  heat  alternating  ; 
periods  of  attack  regular,  and  generally  in  the  morn 
ing  or  evening  ;  burning  thirst,  or  adypsia  ;  fever  of 
either  type ;  burning  in  the  stomach,  sharp  pains  in 
the  limbs,  chest,  back  and  head,  during  the  heat,  with 
difficulty  of  breathing  ;  during  the  sweating  stage, 
heaviness  of  the  head,  buzzing  and  ringing  in  the 
ears ;  between  the  cold  and  hot  stage,  drowsiness, 
languor,  thirst,  nausea,  vomiting  and  hiccup  ;  sweats 
during  sleep,  or  on  waking  in  the  morning.  Dr. 
Watzke  has  cured  chills  and  thirst,  followed  by  high 
fever,  urgent  thirst,  dizziness,  confusion  in  the  head, 
and,  finally,  profuse  perspiration  without  thirst. 
During  the  apyrexia,  pains  in  the  chest  and  head  ; 
weakness  and  faintness ;  small  appetite ;  abdomen 
swollen,  and  affected  with  occasional  colic  pains.  Dr. 
Hartlaub  has  cured  chills  without  thirst,  followed  by 
fever  with  or  without  thirst,  and  then  by  perspiration  : 


148  INTERMITTENT    FEVER. 

bffore  the  chill,  vertigo ;  fainting ;  pains  in  the  side, 
chest,  abdomen  and  back  ;  stretching  and  yawning  : 
during  the  chill,  anxiety ;  pains  in  the  head,  back, 
limbs,  and  pit  of  the  stomach  ;  stretching  and  yawn 
ing  ;  prostration  ;  nausea  ;  vomiting  ;  coldness  of  the 
abdomen,  oppression  of  the  chest :  during  the  fever, 
delirium  ;  pain  in  the  head  ;  vertigo  on  rising  ;  nausea ; 
bitter  taste  ;  aching  pain  in  the  region  of  the  liver ; 
aching  and  burning,  extending  from  the  pit.  of  the 
stomach  to  the  left  hypochondrium  ;  oppression  of  the 
chest :  during  the  intermission,  pale  countenance ; 
white  tongue ;  swelling  of  the  hypochondrium  and 
abdomen  ;  cold,  clammy  sweat ;  throbbing  pain  in  the 
forehead  ;  thirst ;  no  appetite ;  nausea  ;  extreme  de 
bility  ;  pains  in  the  head,  chest,  back,  and  limbs. 

Mental  and  moral  symptoms. — Depression  of  spirits, 
and  irritability  previous  to  the  attack  ;  anxiety,  un 
easiness,  confusion  of  ideas,  which  gradually  increase 
until  the  sweating  commences  ;  occasionally  delirium 
during  the  hot  stage. 

Administration. — Two  drops  of  the  sixth  dilution  in 
an  ounce  of  water, — a  dessert  spoonful  once  in  six 
hours  during  the  apyrexia,  until  the  symptoms  have 
disappeared.  One  dose  of  this  remedy  will  often 
prove  successful  where  allopathic  doses  of  crude  cin 
chona,  and  other  articles,  have  produced  no  effect. 
I  have,  in  two  instances,  succeeded  in  curing  cases 
which  have  resisted  the  old  school  method  for  months, 
with  a  single  drop  of  the  thirtieth  attenuation. 

Remarks. — Arsenicum  is  appropriate  in  any  type  of 
fever  and  ague,  provided  the  symptoms  correspond, 
although  several  authors  especially  commend  it  in  the 
tertian  and  quartan  forms.  Fleischmann  employs 
from  the  third  to  the  sixth  attenuation ;  Watzke 
generally  gives  the  second,  third  and  fourth  dilutions. 
Unless  the  patient  is  unusually  susceptible,  we  prefer 
the  third  to  the  sixth. 

Ipecacuanha. — External  indications. — Before  the 
shiverings,  uneasiness,  stretching  and  lassitude,  with 
cold  sweat  on  the  forehead ;  tongue  clean  or  loaded ; 
during  the  apyrexia,  countenance  pale  or  yellowish. 

Physical  sensations. — Slight  chills,  followed  by  much 
heat ;  or.  severe  Chills  with  little  heat :  aggravation 


INTERMITTENT    FEVER.  149 

of  the  rigours  from  external  heat ;  thirst  only  during 
the  chill  ;  nausea,  vomiting,  and  other  signs  of  gas 
tric  disturbance,  manifest  during  the  heat ;  also,  con 
striction  of  the  chest.  Watzke  advises  ipecac.,  when 
the  chills  are  attended  with  thirst,  confusion  of  ideas, 
and  dull  pains  in  the  head  ;  the  hot  stage,  with  thirst, 
and  sharp  pains  in  the  head  ;  the  sweating  stage,  with 
but  little  or  no  thirst ;  the  apyrcxia,  with  want  of  ap 
petite,  bitter  taste,  oppression  at  stomach,  and  pale 
face.  Hartlaub  has  cured  slight  and  short  chills, 
without  thirst,  followed  with  violent  fever  with  thirst, 
and  succeeded  by  profuse  perspiration,  or  without 
perspiration.  Before  the  chill,  pain  in  the  back : 
during  the  paroxysm,  headache,  dulness  of  intellect, 
gastric  derangement,  nausea  and  vomiting,  oppression, 
contraction,  pain  in  the  chest,  and  cough  :  during  the 
intermission,  bitter  taste  of  food,  much  saliva,  loss  of 
appetite,  vomiting  after  eating,  lassitude,  sleepless 
ness. 

Mental  and  moral  symptoms. — Before  the  chill,  dul 
ness  of  intellect  and  sleeplessness  :  during  the  chill, 
confusion  of  ideas,  irritability,  impatience,  and  indis 
position  to  mental  effort. 

Administration. — Same  as  china. 

Remarks. — This  remedy  has  been  most  frequently 
used  in  fevers  of  the  quotidian  and  tertian  types.  Lo- 
bethal,  Hartmann,  Boenninghausen,  Schmid,  Fleisch- 
mann,  Watzke,  Madden,  Trinks,  Elwert  and  Rummel, 
have  expressed  themselves  strongly  in  favour  of  the 
low  dilutions  of  ipecac,  in  this  disease. 

Bryonia. — External  indications. — During  the  shiver- 
ings,  trembling  and  redness  of  the  face  :  during  the 
heat,  nausea,  and  tendency  to  keep  the  recumbent 
posture  :  during  the  sweating  period,  frequent  sighing 
and  cough. 

Physical  sensations. — Preceding  the  cold  stage,  ver 
tigo,  headache,  and  lassitude  ;  first  stage,  ushered  in 
with  severe  chills  and  trembling,  with  heat  in  the 
head ;  chilly  stage,  more  violent  than  the  hot,  or, 
slight  but  protracted  chills,  and  some  thirst ;  second 
stage,  ushered  in  with  flushes  of  heat  and  slight  chills, 
in  alternation  in  the  first  instance,  afterwards  burn 
ing  heat  and  thirst ;  universal  dry  heat,  external  and 


150  INTERMITTENT    FEVER. 

internal ;  spasmodic  cough ;  vertigo  and  headache 
during  the  fever  ;  shooting  pains  in  the  side  and  ab 
domen  ;  after  the  heat,  profuse  sweat ;  oppression  in 
the  chest,  with  dry  cough  ;  tendency  to  sweat  night 
and  morning  ;  during  the  apyrexia,  constipation,  thirst, 
unhealthy  yellowish  complexion,  and  night  sweats. 

Mental  and  moral  symptoms. — Irascibility,  and  dis 
position  to  look  on  the  dark  side  of  affairs. 

Administration. — Two  drops  of  the  third  dilution  in 
an  ounce  of  water, — a  dessert  spoonful  two  or  three 
times  during  the  apyrexy. 

Eupatorium  perfoliatum. — This  is  a  remedy  which 
we  have  found  highly  serviceable  in  many  cases 
which  have  been  complicated  by  the  abuse  of  calo 
mel  and  quinine.  It  is  particularly  indicated  when 
the  liver  is  much  implicated.  An  intelligent  friend  of 
mine,  who  resides  at  the  West,  in  a  fever  and  ague 
district,  informs  me  that  he  has  for  many  years  past 
made  use  of  a  very  small  quantity  of  an  exceedingly 
weak  infusion  of  this  agent,  as  a  prophylactic  against 
the  disease,  in  his  own  family,  and  with  complete 
success.  He  also  assures  me,  that  he  has  often  cured 
with  astonishing  facility,  cases  which  had  baffled  for 
months  the  ordinary  treatment,  with  a  dose  or  two  of 
an  infusion  very  slightly  bitter. 

The  external  indications  are,  yellow  tinge  of  the 
skin  and  eyes  ;  eyes  dull,  heavy  and  sunken  ;  lips 
pale  or  bluish,  dry  and  cracked. 

Physical  sensations. — Irregular  development  of  the 
paroxysms  ;  frequent  slight  chills  previous  to  the  com 
mencement  of  the  first  stage  :  partial  chills  in  the  back 
and  extremities ;  dizziness,  heaviness  and  ringing  in 
the  head,  during  the  cold  stage  ;  hot  stage  ushered  in 
with  slight  chills,  alternating  with  flushes  of  heat,  un 
til  in  a  short  time  the  heat  becomes  general,  attended 
with  headache,  nausea,  vomiting,  pains  in  the  chest 
and  stomach ;  pains  in  the  bones  ;  tenderness  of  the  ab 
domen  on  pressure  ;  loss  of  appetite  ;  sensation  of  fa 
tigue,  languor  and  debility  ;  constant  inclination  to 
sleep ;  nocturnal  sweats. 

Dr.  Williamson  advises  eupatorium  in  the  guotidrm 
andtertian  types,  when  the  following  symptoms  are  pre 
sent  :  paroxysm  commencing  in  the  morning  ;  thirst 


INTERMITTENT    FEVER.  151 

several  hours  before  the  chill,  continuing  during  the 
chill  and  heat ;  stiffness  of  the  fingers  during  the  chill  ; 
soreness  in  the  bones  ;  aching  pain  with  moaning, 
throughout  the  cold  stage  ;  a  greater  amount  of  shi 
vering  during  the  chill  than  is  warranted  by  the  de 
gree  of  coldness  ;  retching  and  vomiting  of  bile  from 
drinking  ;  vomiting  after  every  draught  ;  vomiting  at 
the  conclusion  of  the  chill  ;  distressing  pain  in  the 
scorbiculus  cordis  throughout  the  chill  and  heat  ;  chill 
beginning  at  nine  o'clock  in  the  morning ;  throbbing 
headache  during  the  chill  and  heat ;  violent  pain  in 
the  head  and  back  before  the  chill ;  inconsiderable 
perspiration,  or  none  at  all ;  fever  in  the  forenoon,  pre 
ceded  by  thirst  early  in  the  morning,  but  no  chill ;  at 
tended  by  fatiguing  cough  and  not  followed  by  sweat ; 
loose  cough  in  the  intermission  ;  cough  in  the  night 
previous  to  the  paroxysm  ;  yellowness  of  the  skin. 

Mental  and  moral  symptoms. — During  the  paroxysm, 
confusion  of  ideas  and  ringing  in  the  ears  ;  discourage 
ment  ;  indifference  to  life ;  dull  of  conception,  and 
discontented  during  the  apyrexy. 

Administration. — One  drop  of  the  first  dilution  in  a 
spoonful  of  water,  during  the  apyrexy.  As  a  prophy 
lactic  against  intermittents,  one  drop  of  the  tincture 
two  or  three  times  a  week. 

Nux  vomica. — External  indications. —  During  the 
chills,  skin,  hands,  feet,  face  and  nails  are  cold  and 
bluish  ;  redness  of  one  or  both  cheeks  ;  spasmodic  con 
tractions  in  the  limbs ;  yawnings  and  stretchings. 
Sweat  profuse,  sometimes  with  a  disagreeable  acid 
smell ;  partial  or  one-sided  sweat ;  pulse  hard,  full  and 
frequent,  or  small,  quick,  or  feeble,  or  intermittent ; 
dryness  of  the  lips  ;  tongue  coated  white  or  yellow. 

Physical  sensations. — First  stage  preceded  by  exter 
nal  and  internal  cold  and  yawning  ;  chills  usually  at 
night,  or  in  the  morning ;  aggravated  by  motion,  drink 
ing,  or  excitement ;  pain  and  heat  in  the  head  ;  thirst 
for  beer  ;  pains  in  the  back  and  loins  ;  during  the  hot. 
stage,  headache,  vertigo,  thirst,  nausea,  pains  in  the 
chest  ;  shivering  on  motion ;  debility ;  during  the 
sweating  stage  the  symptoms  are  mitigated ;  sweat 
and  chills  alternately. 

Watzke  gives  us  the  following  indications:  chills 


INTERMITTENT    FEVER. 

with  thirst ;  headache,  loss  of  consciousness,  or  deli 
rium,  painful  and  inflexible  limbs,  contracted  feel  of 
the  muscles.  Chills  last  four  or  five  hours,  and  not 
followed  by  heat  or  perspiration.  After  the  chill,  ex 
haustion  ;  pains  in  the  hypochondria  from  distention ; 
thirst  and  want  of  appetite  ;  tongue  white  ;  feet  swol 
len  ;  sensation  of  heaviness  wrhen  walking.  Or,  chills 
followed  by  heat  and  sweats  ;  with  thirst ;  anxiety ; 
headache  ;  slight  cough,  with  burning  sensation  in  the 
chest,  worse  during  the  chills  and  heat ;  constipated 
bowels  ;  loss  of  appetite  ;  craving  for  beer  ;  weakness 
and  faintness.  Hartlaub  has  cured  chills  with  or 
without  external  coldness,  and  without  thirst ;  follow 
ed  by  fever  with  thirst,  and  succeeded  or  not  by  per 
spiration.  The  chill  may  be  slight  and  short,  or  vio 
lent  and  protracted,  with  shaking  and  chattering  of 
the  teeth,  and  blue  nails  ;  fever  attended  with  perspi 
ration  about  the  head  and  neck.  Or,  shaking  chills 
with  thirst,  followed  by  fever  with  thirst,  and  by  per 
spiration  ;  chill  preceded  by  thirst,  coldness  increased 
by  drinking.  Or,  alternating  chill  and  fever  ;  motion 
during  the  fever  or  swreat  causes  chills  ;  during  the 
chill,  pain  in  the  back  (sacrum)  ;  during  the  fever, 
headache,  vertigo,  red  face,  pain  in  the  chest,  vomit 
ing  of  water,  bile,  slime  and  food  ;  red  urine  ;  during 
the  intermission,  headache  ;  vertigo  ;  trembling  of  the 
head  on  motion ;  pain  in  the  forehead ;  acid  eructa 
tions  ;  bad  taste  in  the  mouth,  loss  of  appetite,  disgust 
for  food  ;  much  thirst ;  pain  in  the  pit  of  the  stomach 
after  eating  ;  distention  and  pain  of  the  belly  ;  consti 
pation  ;  pressing  at  the  neck  of  the  bladder  after  urin 
ating  ;  drawing  in  the  limbs;  weakness.  Hartmann 
employs  it  when,  at  the  commencement  of  the  parox 
ysm,  there  are  paralytic  weakness  of  the  limbs  ;  dis 
ordered  stomach ;  vertigo,  and  sudden  prostration  of 
strength. 

Mental  and  moral  symptoms. — During  the  chills,  stu 
pid  or  delirious  ;  during  the  fever,  anxious,  melancholy, 
sad,  timid,  apprehensive  of  death.  Occasionally  mo 
nomania  during  the  progress  of  the  disease. 

Administration. — Two  drops  of  the  twelfth  dilution 
in  an  ounce  of  water — a  dessert  spoonful  each  night. 
If  a  cure  is  not  effected  at  the  end  of  a  week,  give  a 


INTERMITTENT    FEVER.  153 

drop  of  the  first  dilution  once   in  six  hours,  until  the 
symptoms  disappear. 

Remarks. — Nux  is  particularly  applicable  to  the  quo 
tidian  and  tertian  types.  If  the  individual  has  been  a 
hard  drinker,  or  luxurious  and  sedentary  in  his  habits, 
the  indications  are  still  stronger. 

Arnica. — External  indications. — Inclination  to  re 
main  quiet. 

Physical  sensations. — Chills  occur  in  the  evening  ; 
thirst ;  contraction  of  the  features.  In  the  hot  stage, 
pain  in  the  back  and  limbs ;  shiverings  from  the 
slightest  exposure  ;  the  hot  and  sweating  stages  slight 
and  of  short  duration.  In  the  apyrexia,  pain  in  the 
stomach  ;  loss  of  appetite  and  general  appearance  of 
wretchedness  and  debility. 

Mental  and  moral  symptoms. — Obstinate  ;  reckless ; 
quarrelsome. 

Administration. — My  friend  Dr.  Shue,  has  been  ac 
customed  to  exhibit  this  remedy  in  alternation  with 
ipecacuanha,  with  marked  benefit.  It  may  be  given 
at  the  first  attenuation — a  few  drops  every  four  hours 
during  the  apyrexy. 

Veratrum  album. — External  indications. — Cold  and 
clammy  perspirations  on  the  forehead  :  shuddering. 
In  the  hot  stage,  coma  and  red  or  purplish  cheeks  ; 
pulse  slow,  and  almost  extinct,  or  small,  quick,  and  in 
termittent  ;  tongue  red  and  dry. 

Physical  sensations. — General  coldness  of  the  whole 
body  ;  cold  stage  of  short  duration,  and  attended  with 
shivering ;  vertigo  ;  nausea  ;  pains  in  the  back  and 
loins  ;  thirst  for  cold  water  ;  the  second  stage  more 
protracted,  and  accompanied  with  headache  ;  short 
dry  cough  ;  fever  with  external  coldness  ;  urine  dark 
coloured ;  diarrhoea  or  constipation  ;  coma  ;  in  the 
third  stage,  profuse  perspiration,  with  thirst  and  drow 
siness. 

Hermann  prescribes  veratrutn,  when  the  chills  are 
followed  by  sweat,  and  afterwards  coldness.  Or,  chills 
alternating  with  fever,  with  thirst ;  vertigo  ;  nausea, 
and  pain  in  the  back,  succeeded  by  fever  with  deli 
rium  ;  flushed  face,  and  tendency  to  sleep.  After  the 
paroxysm,  morbid  appetite.  Or,  cold  stage,  without 
the  hot  or  sweating  stage. 

7* 


154  INTERMITTENT    FEVER. 

Mental  and  moral  symptoms. — In  the  cold  stage,  con 
fusion  of  ideas ;  in  the  hot  stage,  coma  ;  during  the 
apyrexy,  restlessness,  and  sometimes  mental  alien 
ation. 

Administration. — One  drop  of  the  first  dilution  in  an 
ounce  of  water — a  table  spoonful  two  or  three  times 
between  the  paroxysms. 

Belladonna. — External  indications. — Face  pale  and 
bloated  during  the  cold  fit :  eyes  red  and  injected  ; 
face  red  ;  pulsations  of  the  carotids  ;  veins  of  the  fore 
head  swollen  ;  and  some  perspiration  during  the  heat. 

Physical  sensations. — Shiverings  and  heat  alternat 
ing  ;  rigours  followed  by  heat ;  during  the  fever,  burn 
ing  thirst  ;  headache  ;  shootings  in  the  temples  ;  great 
sensibility  to  impressions ;  delirium  ;  sweat  of  the 
parts  covered  only ;  stitches  in  the  chest ;  dimness  of 
sight. 

Mental  and  moral  symptoms.  Quarrelsome  and 
passionate  during  the  paroxysm  ;  or,  great  agitation  ; 
mistrustful ;  constant  dread  of  evil ;  visions  of  fright 
ful  or  ludicrous  objects  ;  delirium. 

Administration. — A  drop  of  the  third  dilution  in 
water,  every  four  hours  between  the  paroxysms. 

Carbo  veg. — ^External  indications  :  Before  the  chill, 
pale  face  ;  cold  feet  and  hands  ;  during  the  fever,  red 
face ;  during  the  intermission,  nocturnal  sweat ;  cold 
sweat  on  the  face  and  limbs. 

Physical  sensations.  —  Tertian  type,  kept  up  by 
roused  psora  ;  rigours,  preceded  by  throbbing  of  the 
temples ;  rending  in  the  teeth  and  bones ;  and  at 
tended  with  thirst  and  sense  of  prostration ;  hot  stage, 
attended  with  thirst,  or  absence  of  thirst;  headache; 
vertigo  ;  impaired  vision  ;  nausea ;  pains  in  the  sto 
mach  and  chest  ;  acid  sweats  in  the  morning  :  in 
the  intermission,  paleness  ;  emaciation ;  distention  of 
the  stomach;  headache;  loss  of  appetite ;  lassitude 
and  disturbed  sleep. 

Mental  and  moral  symptoms. — Anxiety  and  fear  in 
the  evening  ;  intellect  dull. 

Administration. — One  grain  of  the  third  trituration 
in  two  ounces  of  water,  a  tablespoon ful  once  in  four 
hours  during  the  apyrexia. 


INTERMITTENT    FEVER.  155 

Remarks. — This  remedy  was  supposed  by  Hahne- 
mann  to  be  of  especial  service,  in  those  old  and  obsti 
nate  cases  of  intermittent  fever,  which  appeared  to 
be  connected  with  a  psoric  miasm  lurking  in  the 
system.  Hartlaub  has  found  it  curative  in  similar 
cases.  It  is  adapted  to  the  tertian  type. 

Pulsalilla. — External  indications. — Face  pale  dur 
ing  the  cold  stage ;  face  red  and  bloated  in  the  hot 
stage,  sometimes  with  sweat  on  the  face ;  swelling  of 
the  veins ;  anxious  and  rapid  respiration ;  eyes  dull, 
and  cloudy ;  inclination  to  remain  in  the  recumbent 
posture ;  pulse  quick  and  small,  or  full  and  slow,  or 
feeble  and  suppressed ;  tongue  coated,  whitish,  gray 
ish,  or  yellowish. 

Physical  sensations. — Chills  in  the  evening  or  af 
ternoon  ;  vertigo,  pain  and  heaviness  in  the  head ; 
sensation  of  cold  from  slight  exposure  ;  irregular  dif 
fusion  of  heat,  chiefly  in  the  face,  or  on  one  side  ; 
absence  of  thirst:  after  the  paroxysm,  headache,  op 
pression  of  the  chest,  moist  cough,  bitter  taste. 

Or,  according  to  Lobethal,  Hartmann  arid  Watzke, 
chills  without  thirst;  fever,  with  thirst,  and  dull 
headache ;  sweating  very  slight.  Or,  chilis  com 
mencing  with  vomiting,  with  slight  thirst  during  the 
cold,  hot  and  sweating  stages ;  diarfhcBa ;  loss  of  ap 
petite. 

Mental  and  moral  symptoms. — Daring  the  paroxysm, 
anxiety  ;  sadness  ;  taciturn  ;  apprehension  ;  dread  of 
sudden  death  :  great  depression  of  spirits  during  the 
apyrexia. 

Administration. — Two  drops  of  the  first  dilution  in 
an  ounce  of  water, — a  dessert  spoonful  three  or  four 
times  during  the  apyrexia. 

Remarks. — When  the  attacks  have  been  incited  by 
abuse  of  fat  and  indigestible  food,  or  are  connecte'd 
with  any  derangement  of  the  menstrual  function,  pul- 
satiila  is  appropriate.  It  has  been  most  frequently 
employed  in  the  quartan  type. 

Antimonium  crudam. — External  indications. — Face 
and  eyes  of  a  yellowish  hue  ;  yellow  or  whitish  fur 
upon  the  tongue  ;  pulse  quick  or  slow. 

Physical  sensations. — Tertian  type  ;  short  chills, 
followed  by  fever,  with  pain  in  the  chest  and  pit  of 


156  INTERMITTENT    FEVER. 

the  stomach ;  predominance  of  gastric  or  bilious 
symptoms ;  frequent  nausea  and  vomiting  ;  bitter 
taste  in  the  mouth  ;  thirst ;  diarrhoea  ;  distention  of 
the  stomach. 

Mental  and  moral  symptoms. — During  the  apyrexy, 
indifference  to  life  ;  during  the  paroxysm,  peevish ; 
dread  of  misfortune  ;  out  of  humour. 

Administration. — Two  drops  of  the  third  dilution  in 
an  ounce  of  water, — a  tablespoonful  once  in  six  hours 
during  the  intermission. 

Ignatia. — External  indications. — During  the  chill, 
pale  or  sunken  face  ;  bilious  vomiting :  during  the 
second  stage,  pale  face,  or  one  cheek  red  and  the 
other  pale  :  during  the  intermission,  lips  dry  and 
cracked  ;  countenance  pale  ;  hard,  dry  stools  ;  nettle- 
rash  ;  pulse  variable  ;  tongue  white. 

Physical  sensations, — Rigours,  with  thirst  for  cold 
water ;  nausea  and  vomiting ;  pain  in  the  back  and 
limbs  ;  oppression  at  the  chest ;  loose,  short  cough ; 
coldness,  relieved  by  external  heat ;  heat  general 
during  the  second  stage  ;  vertigo ;  headache  ;  pain  in 
the  back  and  limbs  ;  drowsy  ;  absence  of  thirst  during 
the  hot  and  sweating  period  ;  during  the  intermission, 
pressing  and  shooting  pains  in  the  head,  back,  and 
limbs  ;  loss  of  appetite. 

Mental  and  moral  symptoms. — Occasionally  delirious 
during  the  fever ;  suppressed  grief,  with  sighing ; 
timid,  sad,  irresolute,  and  inclined  to  weep  during  the 
apyrexy. 

Administration. — Same  as  belladonna. 

Cocculus. — External  indications. — Trembling  during 
the  first  stage  ;  redness  of  the  cheeks  during  the  heat  ; 
pulse  full,  hard  and  frequent  ;  tongue  clean  or  loaded. 

Physical  sensations. — Transient  chills  ;  skin  hot  to 
the  touch,  in  the  first  stage ;  burning  heat  in  the 
cheeks ;  cramps  in  the  loins  and  stomach,  and  but 
slight  fever  in  the  second  stage  ;  apyrexy,  accompa 
nied  with  vertigo ;  dull  pain  in  the  head,  and  general 
debility. 

Mental  and  moral  symptoms. — Apprehension  of  ap 
proaching  evil  ;  fear  of  death,  during  the  paroxysm  ; 
sadness  and  discouragement  during  the  apyrexy. 

Administration. — Two  drops  of  the  third  dilution,  in 


INTERMITTENT    FEVER.  157 

an  ounce  of  water — a  tablespoonful  every  four  hours 
between  the  paroxysms. 

Lachesis. — External  indications. — Face  pale,  or  lead 
en,  discoloured  or  yellowish,  during  the  cold  stage  and 
the  intermission  ;  red  spots  on  the  cheeks  while  the 
fever  is  on  ;  blue  circle  round  the  eyes  ;  red  swelling 
of  the  face  ;  agitation  and  tossing  in  the  cold  and  hot 
stages ;  pulse  intermittent,  or  feeble  and  frequent ; 
tongue  dry  in  the  second  stage. 

Physical  sensations. — Most  of  the  time,  icy  coldness 
of  the  limbs  ;  rigours  only  partial  ;  pains  in  the  limbs  ; 
fever  at  night  or  in  the  evening,  with  headache  and 
great  debility  ;  oppression  at  the  chest ;  severe  pains 
in  the  limbs ;  thirst,  and  sometimes  bilious  vomiting. 

Mental  and  moral  symptoms. — In  the  apyrexy,  melan 
choly,  violent  jealousy  ;  weakness  of  memory  :  during 
the  paroxysm,  delirium ;  loquacity  ;  irritability. 

Administration. — One  grain  of  the  third  trituration 
in  two  ounces  of  water — a  dessert  spoonful  every 
twelve  hours  until  the  desired  effect  is  obtained. 

Sabadilla. — External  indications. — In  the  cold  stage, 
trembling  of  the  limbs,  spasmodic  cough :  in  the  hot 
stage,  yawning  and  stretching ;  pulse  variable ; 
tongue  natural. 

Physical  sensations. — The  different  stages  imper 
fectly  developed;  external  coldness  with  shivering; 
dry  cough,  pains  in  the  chest,  limbs  and  bones  in  the 
first  stage  :  during  the  apyrexia,  dull  pains,  with  sense 
of  fatigue. 

Mental  and  moral  symptoms. — During  the  paroxysm, 
inability  to  collect  or  arrange  the  thoughts  ;  delusions 
of  the  imagination  with  respect  to  oneself;  delirium. 

Remarks. — This  remedy  is  useful  when  the  malady 
has  been  preceded  for  some  time  by  gastric  derange 
ment,  or  in  cases  complicated  by  abuse  of  quinine. 

Administration. — Same  as  veratrum. 

Sulphur. — External  indications. — Countenance  pale 
or  hot  during  the  first  stage  ;  circumscribed  redness 
of  the  cheeks  during  the  second  stage  ;  sweat  upon  the 
head,  face,  and  hands  ;  eruptions  or  scabs  upon  the 
face,  hands,  or  limbs  ;  pulse  hard,  full  and  quick  ; 
tongue  natural. 

Physical    sensations. — Previous  to  the  first    stage, 


158  INTERMITTENT    FEVER. 

thirst  and  lassitude  ;  chilliness  in  the  evening  or  at 
nightt  and  sometimes  in  the  afternoon  ;  shiverings  in 
the  back,  chest  and  arms,  with  coldness  of  the  hands, 
feet  and  nose  ;  heat  attended  with  thirst ;  burning 
sensation  in  the  hands  and  feet ;  bruised  and  tired 
feelings  in  the  limbs  ;  palpitation  of  the  heart ;  per 
spiration  easily  excited  in  the  head,  neck,  hands,  &c. 

Mental  and  moral  symptoms. — In  the  apyrexy,  sad 
ness,  with  frequent  inclination  to  weep  ;  during  the 
paroxysm,  irritable  and  peevish  ;  thoughts  incline  to 
religious  subjects. 

Administration. — One  grain  of  the  first  trituration  in 
four  parts — a  powder  every  twelve  or  twenty-four 
hours  until  decided  amendment  or  aggravation  of 
symptoms  ensue. 

Remarks. — Sulphur  has  most  often  been  employed 
in  the  quotidian  type.  In  many  cases  of  fever  and 
ague  occurring  in  psoric  subjects,  it  will  also  prove 
eminently  serviceable. 

Cina. — Hermann  and  Gross  have  found  cina  cura 
tive  when  during  the  paroxysm  there  are,  pale  coun 
tenance  ;  canine  appetite;  headache;  nausea;  foul 
breath  :  during  the  intermission,  cold  surface  ;  morbid 
appetite  ;  lassitude  ;  occasional  sweats. 

Hartlaub  advises  capsic  im  in  chills  with  thirst ; 
headache  ;  mucous  vomiting  ;  flow  of  saliva  ;  great  and 
painful  swelling  of  the  spleen  ;  rending  pains  in  the 
back,  loins,  and  knees  ;  yawning  and  stretching  ;  fever, 
with  or  without  thirst ;  headache  ;  bad  taste  ;  cutting 
pains  in  the  belly  ;  pains  in  the  chest,  back,  and  legs ; 
after  the  fever,  slight  or  profuse  sweat ;  in  the  inter 
mission,  ash-coloured  countenance  ;  swelling  of  the 
spleen  and  the  feet ;  constant  chilliness  and  coldness  ; 
drawing  pains  in  different  parts  when  in  the  air  ; 
useful  in  relapses  after  abuse  of  quinine. 

The  same  writer  commends  natrum  mur,  in  chills 
with  little  or  no  thirst ;  sharp  pains  in  the  forehead, 
back,  and  bones  ;  short  breath  ;  yawning  and  sleepi 
ness,  followerd  by  fever,  with  great  thirst ;  severe 
rending  or  throbbing  pains  in  the  head  and  forehead ; 
in  the  intermission,  yellowish  face  ;  white  tongue ; 
hard  and  scanty  stools  ;  swollen  stomach  ;  headache  ; 
weak  eyes  ;  bitter  taste  ;  no  appetite  ;  great  thirst  ; 


YELLOW    FEVER.  159 

pit  of  the  stomach  painful  to  the  touch;  sleepy  in  the 
day  time,  but  sleepless  at  night ;  lassitude  and  debili 
ty.  It  also  cures  tertian  and  quotidian  types,  with 
chills  only. 

Administration. — A  drop  of  the  first  dilution  once  in 
four  hours  between  the  paroxysms. 


CHAPTER    XVI. 

YELLOW   FEVER. 

This  fever  is  exceedingly  uncertain  in  its  course,  vio 
lence,  and  duration.  It  may  strike  its  victim  suddenly 
prostrate,  overwhelming  in  its  severity  the  whole  sys 
tem,  and  thus  preventing  a  single  rally  of  the  circula 
tory  vessels  ;  or  it  may  advance  mildly,  differing  but 
little  from  an  ordinary  attack  of  remitting  fever.  In 
some  instances  it  bears  a  strong  resemblance  to  the 
higher  grades  of  bilious  fever.  Much  depends  upon 
the  peculiar  circumstances  of  the  individual  attacked. 
If  he  is  recently  from  a  temperate  climate,  and  unac 
customed  to  hot  regions,  he  will  be  more  susceptible 
to  the  action  of  the  poison  than  if  he  had  been  pre 
viously  acclimated. 

Medical  men  have  supposed  that  after  a  certain 
period  of  exposure,  the  system  becomes  so  completely 
accustomed  to  the  miasm,  that  it  loses  all  suscepti 
bility  to  its  influence,  and  in  this  manner  the  process 
of  acclimation  is  accomplished.  There  is  doubtless 
some  truth  in  this  idea,  but  there  are  other  causes 
which  exercise  quite  as  important  an  influence  in  this 
process.  Those  persons  who  abandon  a  temperate  for 
a  residence  in  a  tropical  climate,  do  so  in  that  physi 
cal  condition  which  the  requirements,  habits,  and  re 
gimen  of  the  former  naturally  generate.  In  a  previous 
chapter  we  have  seen,  that  in  cold  regions,  where  the 
atmosphere  is  highly  condensed,  a  large  amount  of 
animal  food  is  requisite  to  supply  the  system  with  suffi 
cient  carbon  and  hydrogen  to  resist  and  neutralize  the 


160  YELLOW    FEVER. 

action  of  the  inspired  oxygen.  With  these  habits, 
appropriate  only  where  a  condensed  atmosphere  is  re 
spired,  individuals  seek  the  tropics,  with  bodies  abound 
ing  in  carbon,  and  continuing,  in  most  instances,  their 
accustomed  regimen  of  animal  food  and  stimulants, 
thus  burdening  their  systems  with  an  amount  of  the 
elements  of  nutrition  far  greater  than  the  oxygen  con 
tained  in  the  rarefied  air  which  they  inhale  can  de 
compose. 

It  is  probable,  therefore,  that  one  of  the  chief  predis 
posing  causes  of  yellow  fever,  is  the  presence  of  a 
greater  amount  of  carbon  in  the  system  than  the  in 
spired  air  can  properly  act  upon.  The  exact  equili 
brium  between  the  supply  of  the  elements  of  the  food 
and  the  absorbed  oxygen,  is  disturbed  ;  the  carbon  pre 
dominates,  and  all  of  those  derangements  which  pro 
ceed  from  a  superabundance  of  this  agent,  necessarily 
ensue. 

The  inhabitants  of  tropical  latitudes  have  compara 
tively  but  little  desire  for  animal  food,  but  prefer  fari 
naceous  diet,  vegetables  and  fruits :  in  this  manner 
naturally  securing  to  themselves  a  due  proportion  be 
tween  the  elements  assimilated  and  the  oxygen  ab 
sorbed  ;  while  the  inhabitants  of  the  north  find  it  ne 
cessary  to  consume  large  quantities  of  meat  and  other 
articles  abounding  in  the  elements  of  nutrition,  in  order 
to  preserve  a  healthy  equilibrium.  We  therefore  most 
strongly  urge  it  upon  those  who  remove  from  cold  to 
hot  climates,  to  adapt  their  systems  by  appropriate 
regimen,  and  strict  temperance  in  all  things,  for  the 
change,  and  we  confidently  predict  that  they  will  en 
joy  as  great  an  immunity  from  this  dreadful"  scourge, 
as  the  natives  themselves. 

Diagnosis.  The  premonitory  symptoms  of  yellow 
fever  are  giddiness,  wandering  pains  in  the  back  and 
limbs,  slight  chills,  nausea,  and  frequent  sensations  of 
faintness. 

After  these  symptoms  have  continued  a  few  hours,  a 
decided  reaction  occurs  :  the  circulation  becomes 
excited,  the  face  flushed,  the  eyes  red,  there  are  vio 
lent  pains  in  the  head,  back,  loins,  and  extremities, 
distress  of  stomach,  and  vomiting  of  acid  bilious  mat 
ters,  the  surface  becomes  dry  and  burning  hot,  mouth 


YELLOW    FEVEfi.  161 

and  throat  dry,  with  intense  thirst,  and  sometimes  de 
lirium. 

The  duration  of  this  paroxysm  is  usually  about 
twenty-four  hours,  although  occasionally  it  continues 
two  or  three  days,  after  which  there  is  a  remission  of 
all  the  symptoms,  except  a  distressed  sensation  in  the 
stomach,  with  nausea  and  vomiting.  The  patient  re 
mains  in  this  state  with  a  considerable  degree  of  com 
fort  for  a  few  hours,  when  there  is  a  recurrence  of 
many  of  the  former  symptoms  in  an  aggravated  form. 
The  stomach  now  becomes  extremely  painful  and  sen 
sitive,  vomiting  is  violent  and  incessant,  the  fluids 
ejected  are  of  a  darker  colour,  the  skin  and  eyes  ac 
quire  a  yellow  tinge,  and  the  mind  becomes  confused 
and  wandering. 

The  duration  of  this  second  stage  varies  from  twelve 
to  forty-eight  hours,  with  sometimes  slight  remissions 
towards  the  termination  of  the  paroxysm,  when  the 
third  or  last  stage  sets  in.  This  stage  is  character 
ized  by  the  complete  development  of  the  dreaded 
"  black  vomit."  At  this  period,  the  powers  of  the  sys 
tem  all  sink  rapidly  ;  the  pulse  flags,  and  perhaps  in 
termits  ;  the  tongue  becomes  dry,  black  and  shrivelled  ; 
the  breathing  irregular  and  laborious  ;  cramps  seize 
the  calves  of  the  legs  and  the  bowels ;  the  whole  counte 
nance  loses  its  natural,  lifelike  expression  ;  the  extrem 
ities  become  cold  ;  colliquative  sweats,  diarrhoea, 
haemorrhages,  and  loss  of  intellect  occur,  and,  finally, 
dissolution  ends  the  scene. 

This  is  only  a  brief  outline  of  the  more  ordinary 
symptoms  and  course  of  the  malady,  and  will,  we 
trust,  serve  to  aid  the  inexperienced  practitioner  in 
his  diagnosis.  Each  case,  however,  must  necessarily 
present  modifications  according  to  the  predisposition, 
habits,  and  peculiar  circumstances  of  the  individual 
attacked. 

Causes. — When  animal  and  vegetable  matters  are 
submitted,  for  a  considerable  length  of  time,  to  the 
daily  influence  of  intense  solar  heat,  and  a  certain 
amount  of  moisture  in  the  crowded  and  filthy  streets 
of  cities,  or  other  confined  places,  a  miasm  is  gene 
rated,  which,  under  favourable  circumstances,  will 
ause  yellow  fever.  Concerning  the  nature  of  this 


162  YELLOW    FEVER. 

miasm  we  know  nothing  ;  but  it  is  evident,  that  the 
continued  high  degree  of  temperature  to  which  these 
substances  are  exposed,  and  the  confinement  of  their 
noxious  emanations  within  the  walls  of  crowded  cities 
developes  a  more  virulent  morbific  agent  than  is  the 
case  when  the  same  matters  are  exposed  in  the  open 
country,  or  to  a  more  irregular  and  less  intense  heat, 
such  as  usually  occurs  in  more  temperate  localities. 

There  are  several  other  causes  which  act  as  pow 
erful  predisposing  influences,  one  of  the  most  impor 
tant  of  which,  as  before  mentioned,  is  the  too  free  use 
of  animal  food  and  stimulants.  We  may  also  include 
in  this  category,  irregular  habits,  mental  anxiety,  de 
pression  of  spirits,  fear,  grief,  exposure  to  night  air 
or  to  a  burning  sun,  and,  indeed,  whatever  else  tends 
to  debilitate  the  organism. 

Therapeutics. — The  remedies  most  commonly  appli 
cable  to  the  treatment  of  this  affection  are,  ipecacu 
anha,  belladonna,  bryonia,  rhus,  arsenicum,  and  aconite. 
The  other  medicines  likely  to  prove  serviceable  are, 
nux  vomica,  mercurius,  veratrutn,  china,  sulphur,  can- 
tharides,  carbo  vcg.,  and  crotalus.  The  late  and  much 
lamented  Dr.  Taft,  of  New  Orleans,  was  eminently 
successful  in  his  treatment  of  the  yellow  fever  as  it 
occurred  in  that  city.  Sometime  since,  we  had  the 
pleasure  of  perusing  a  letter  from  a  highly  intelligent 
gentleman  of  New  Orleans,  in  which  he  states,  that 
the  success  of  Dr.  T.  was  so  great  in  this  malady,  as 
to  attract  the  marked  attention  of  a  large  number  of 
citizens  ;  and  the  writer  expresses  a  deliberate  opin 
ion,  that  a  new  and  favourable  era  would  soon  have 
occurred  in  the  management  of  this  formidable  affec 
tion,  if  the  able  and  accomplished  Taft  had  survived. 
The  remedies  which. this  physician  found  most  suc 
cessful,  and  upon  which  he  chiefly  relied,  were 
aconite,  ipecacuanha,  belladonna,  and  bryonia,  in  the 
first,  and  sometimes  second  stages  ;  in  the  second  and 
third  stages,  in  addition  to  the  above,  rlius  tox.,  arsen 
icum,  veratrum,  cantharidcs,  carbo  vcg.,  nux  vom.  These 
medicines  were  usually  employed  at  the  first  attenu 
ation,  and  frequently  repeated,  either  singly  or  in  al 
ternation,  as  the  circumstances  of  each  case  appeared 
to  require. 


YELLOW    FEVER.  103 

When  the  first  symptoms  declare  themselves,  as 
dizziness,  slight  chills,  pains  in  the  back  and  limbs, 
uneasy  sensations  at  the  epigastrium,  with  nausea, 
vomiting,  and  sensation  of  faintness,  ipecacuanha,  at 
the  third  attenuation,  should  be  immediately  exhibited. 
This  remedy  may  also  be  found  serviceable  during  the 
second  and  third  stages,  in  alternation  with  some 
other  article.  Should  the  malady  continue  to  pro 
gress,  the  following  medicines  should  be  considered, 
and,  in  proper  cases,  promptly  administered. 

Belladonna. — External  indications. — Glowing  red 
ness  and  bloated  appearance  of  the  face  ;  eyes  red 
and  sparkling,  or  fixed,  glistening,  and  prominent ; 
tongue  loaded  with  whitish  mucus,  or  yellowish,  or 
brownish  ;  pulse  variable. 

Physical  sensations. — Dry  burning  heat ;  sharp,  dart 
ing  and  shooting  pains  in  the  head  ;  violent  throbbings 
in  the  head  ;  burning  thirst ;  painful  heaviness  and 
cramp-like  pains  in  the  back,  loins,  and  legs  ;  pressure, 
cramp-like,  and  contractive  pains  in  the  stomach  ;  in 
clination  to  vomit,  or  violent  vomitings. 

Mental  and  moral  symptoms. — During  the  remission, 
melancholy;  dejection:  when  reaction  comes  on, 
great  agitation,  with  continual  tossing  and  anguish. 

Administration. — Belladonna  is  for  the  most  part  ap 
plicable  to  the  first  stage  of  yellow  fever.  One  drop 
of  the  third  potency  may  be  given  once  in  one,  two, 
three,  or  four  hours,  according  to  the  violence  of  the 
symptoms. 

Bryonia. — External  indications. — Skin  yellow  ;  eyes 
red,  or  dull  and  glassy,  or  sparkling  and  filled  with 
tears  ;  tongue  dry,  and  loaded  with  a  white  or  yellow 
coating  :  pulse  rapid,  and  full,  or  weak  and  rapid. 

Physical  sensations. — Severe  pain  and  burning  sen 
sation  in  the  stomach  ;  vomiting,  particularly  after 
drinking;  burning  thirst;  pains  in  the  back  and 
limbs ;  headache  aggravated  by  movement ;  eyes 
painful  on  motion  ;  sense  of  fulness  and  oppression  in 
the  stomach  and  intestines. 

Menial  and  moral  symptoms. — Anxiety,  with  dread 
and  apprehension  respecting  the  future  ;  loss  of  memo 
ry  ;  delirium. 

Administration. — Two  drops  of  the  first  dilution  in 


164  YELLOW    FEVER. 

an  ounce  of  water, — a  dessert  spoonful  every  two 
hours  until  an  impression  is  produced. 

R/ius. — External  indications. — Surface  of  a  dirty  yel 
low  colour  ;  eyes  glazed  and  sunken  ;  tongue  dry  and 
black;  lips  dry  and  brownish  ;  pulse  quick  and  small ; 
loquacious  delirium,  or  coma  with  stertorous  breath 
ing  ;  constant  moaning. 

Physical  sensations. — Distressing  pain  and  burning 
in  the  stomach  ;  nausea  and  vomiting  ;  paralysis  of 
the  lower  extremities  ;  spasms  in  the  abdomen  ;  want 
of  power  over  the  abdominal  muscles;  colic;  diar 
rhoea  ;  difficulty  in  deglutition,  and  pain  on  swallowing. 

Mental  and  moral  symptoms. — Intellect  dull  and 
clouded  ;  constant  uneasiness  ;  delirium. 

Administration. — Two  drops  of  the  third  dilution  in 
an  ounce  of  water, — a  dessert  spoonful  at  a  dose,  and 
repeated  as  the  symptoms  require.  In  cases  where 
this  dilution  is  not  sufficiently  prompt  or  active,  the 
first  dilution  may  be  substituted  in  drop  doses. 

Arsenicum. — External  indications. — Face  of  a  yel 
lowish  or  bluish  colour  ;  eyes  dull  and  sunken,  with  a 
dark  mark  under  them ;  sclerotica  yellow ;  nose 
pointed  ;  coldness  of  the  body,  with  cold  and  clammy 
sweat  ;  lips  and  tongue  brown  or  black  ;  colliquative 
sweats ;  pulse  irregular,  or  quick,  weak,  small  and 
frequent,  or  suppressed  and  trembling. 

Physical  sensations. — Sense  of  extreme  debility  ; 
dull ,  throbbing,  stunning,  or  shooting  pains  in  the 
head  ;  burning  or  sharp  and  darting  in  the  epigastrium, 
or  in  the  region  of  the  liver ;  limbs  feel  stiff  and  use 
less  ;  frequent  evacuations,  with  tenesmus,  or  painless 
and  involuntary  ;  oppression  at  the  chest,  with  rapid 
and  anxious  respiration;  cramps  in  the  calves  of  the 
legs ;  great  oppression  at  the  stomach,  with  violent 
vomiting,  especially  after  drinking ;  drawing  and 
cramp-like  pains  in  the  abdomen  ;  sensation  as  if  a 
weight  was  pressing  upon  the  abdomen. 

Mental  and  moral  symptoms. — Indifference  ;  weak 
ness  of  memory  ;  stupidity  ;  delirium,  with  great  flow 
of  ideas  ;  loss  of  consciousness  and  of  sense  ;  raving. 

Administration. — In  urgent  cases,  a  drop  of  the  third 
dilution  may  be  exhibited  every  half  hour,  until  some 
change  is  produced  in  the  symptoms.  In  less  danger- 


YELLOW    FEVER.  165 

cms  instances,  the  intervals  of  administration  may  be 
lengthened  as  circumstances  require. 

Aconite. — External  indications. — Suitable  in  the  first 
and  second  stages,  when  there  are  burning  and  dry 
skin  ;  red  cheeks  ;  full  and  rapid  pulse  ;  red  and  sen 
sitive  eyes  ;  tongue  natural  or  covered  with  a  whitish 
slimy  coat ;  lips  and  mouth  dry  ;  vomiting  of  mucus 
and  bile  ;  urine  dark  red. 

Physical  sensations. — Violent  febrile  reaction  ;  sen 
sation  of  intense  heat ;  great  thirst ;  acute  pains  in 
the  temples,  forehead,  or  on  one  side  of  the  head  ;  ver 
tigo  on  rising,  eyes  weak  and  sensitive  to  light ;  pains 
and  soreness  in  the  back  and  limbs ;  nausea  ;  general 
sense  of  debility ;  great  heat  and  irritability  of  the 
stomach  ;  short  and  anxious  respiration. 

Mental  and  moral  symptoms. — When  the  fever  is  on, 
great  anguish,  anxiety,  and  restlessness  ;  for  the  most 
part  nightly  delirium. 

Administration. — A  drop  of  the  first  dilution  may  be 
given  in  water  every  two  hours,  until  the  active  febrile 
symptoms  abate.  Aconite  and  belladonna  may  some 
times  be  alternated  with  benefit  in  the  first  period  of 
the  disease. 

Remarks. — In  a  majority  of  cases,  a  few  doses  of 
this  remedy  will  be  found  indispensable,  during  the 
first  reaction.  This  corresponds  with  the  experience 
of  several  physicians  with  whom  we  have  communi 
cated  upon  the  subject,  and  whose  opportunities  of 
observation  have  been  ample.  Dr.  Hempel  thinks  it 
probable  that  aconite  is  the  only  specific  for  this  dis 
ease. 

Nux  vomica. — External  indications. — Skin  yellow  ; 
face  pale  or  yellowish,  especially  round  the  nose  and 
mouth  ;  lower  part  of  the  sclerotica  yellow  ;  eyes  in 
flamed  with  redness  of  the  conjunctiva  ;  eyes  surround 
ed  with  a  dark  circle  and  full  of  tears  ;  tongue  with  a 
thick  white  or  yellow  fur,  or  dry,  cracked,  and  brown, 
with  red  edges  ;  pulse  variable. 

Physical  sensations. — Burning  pains  in  the  stomach  ; 
pressure  or  cramp-like  pains  in  the  epigastrium  ;  vom 
iting  of  acid,  bilious,  or  mucous  matters  ;  frequent  and 
violent  hiccough* ;  eyes  sensitive  to  light ;  vertigo,  or 
pains  in  the  head  ;  tremours  of  the  limbs  :  cramps  in 


166  YELLOW    FEVER, 

different  parts  ;  thirst  for  beer,  brandy,  or  some  stimu 
lant  ;  contraction  of  the  abdominal  muscles  ;  loose  dis 
charges  of  slimy  or  bilious  matters  or  blood  ;  burning 
pains  at  the  neck  of  the  bladder,  with  difficulty  in 
urinating  ;  coldness,  paralysis,  and  cramps  in  the  legs  ; 
feet  benumbed  and  cramped. 

Mental  and  moral  symptoms. — Excessive  anxiety,  un 
easiness,  fear  of  death ;  despair,  or  loss  of  conscious 
ness  and  delirium,  with  moaning  or  muttering. 

Administration. — Two  drops  of  the  third  dilution  in 
an  ounce  of  water, — a  dessert  spoonful  once  in  from 
two  to  six  hours. 

Mercurius. — External  indications. — Yellow  colour 
of  the  skin  ;  eyes  red,  blood  vessels  of  sclerotica  inject 
ed  ;  eyes  sensitive  to  light ;  paralysis  of  one  or  more 
limbs ;  tongue  with  moist  thick  white  fur,  or  dry  and 
brown  mucus ;  faeces  variable ;  pulse  irregular,  or 
quick,  strong,  and  intermittent,  or  weak  and  trem 
bling. 

Physical  sensations. — Excessive  inclination  to  sleep, 
or  restlessness  from  nervous  irritation  ;  sense  of  fatigue 
and  debility;  rapid  loss  of  strength;  dizziness,  or  vio 
lent  pain  in  the  head ;  violent  convulsive  vomiting  of 
mucous  and  bilious  matters  ;  burning  pain  and  tender 
ness  of  the  stomach  ;  constipation,  or  diarrhoea  with 
discharges  of  mucus,  bile,  or  blood ;  coldness  of  the 
arms  and  legs,  with  cramps  ;  excitability  and  sensi 
bility  of  all  the  organs. 

Mental  and  moral  sy?npto?ns. — Anguish  and  agita 
tion  ;  weakness  of  memory  ;  apprehensions  ;  discour 
agement  ;  moroseness  ;  raving. 

Administration. — A  grain  of  the  third  trituration  in 
an  ounce  of  water — a  dessert  spoonful  every  two,  four 
or  six  hours. 

Veratrum  alb.  External  indications. — Face  of  a  yel 
lowish  or*  bluish  colour,  cold  and  covered  with  cold 
perspiration  ;  eyes  dull,  clouded,  yellowish  and  wa 
tery  ;  lips  and  tongue  dry,  brown,  and  cracked ;  hic 
cough  ;  coldness  of  the  hands  and  feet ;  trembling  and 
cramps  of  the  feet,  hands,  and  legs  ;  evacuations  loose, 
blackish  or  yellowish  ;  pulse  slow  and  almost  extinct, 
or  small,  quick,  and  intermittent. 

Physical  sensations. — General  prostration  of  strength  : 


YELLOW  FEVL:R.  1C7 

confusion  of  head,  or  vertigo  ;  deafness  ;  difficult  deg 
lutition  ;  intense  thirst ;  violent  vomiting  of  green  bile 
and  mucus,  or  black  bile  and  blood  ;  burning  in  the 
stomach  ;  great  exhaustion ;  cramps  in  the  stomach, 
abdomen,  and  limbs  ;  diarrhoea. 

Mental  and  moral  symptoms. — Timid  ;  despondent ; 
restless  ;  loss  of  sense  :  coma  or  violent  delirium. 

Administration. — A  drop  of  the  third  dilution  in  an 
ounce  of  water ;  a  dessert  spoonful  frequently  repeat 
ed,  until  an  effect  is  apparent. 

Sulphur. — External  indications. — Face  pale,  or  yel 
lowish  ;  eyes  red,  or  yellowish  ;  aphtha3  in  the  mouth  ; 
tongue  dry,  rough,  and  reddish,  or  with  white  or 
brownish  coat ;  pulse  hard,  quick,  and  full ;  fa3ces 
whitish,  greenish,  or  brownish,  bloody  or  purulent. 

Physical  sensations. — Dizziness,  or  sharp  pains  in 
the  head  ;  itching  and  burning  pain  in  the  eyes  ;  roar 
ing  in  the  ears  ;  nausea,  with  trembling  and  weak 
ness  ;  vomiting  of  bilious,  acid,  bloody,  or  blackish 
matters  ;  pressure  and  pain  in  the  stomach  ;  pains  in 
the  back  and  loins. 

Mental  and  moral  symptoms. — Melancholy ;  sad  ; 
timid  ;  undecided  ;  wandering. 

Administration. — A  grain  of  the  third  trituration  in 
an  ounce  of  water ;  a  dessert  spoonful  every  four 
or  six  hours,  extending  or  diminishing  the  intervals 
according  to  the  exigencies  of  the  case. 

Cantharides  is  sometimes  indicated  in  the  third 
stage  with  complete  insensibility,  cramps  in  the  ab 
dominal  muscles  and  legs,  suppression  of  urine,  has- 
morrhages  from  the  stomach  and  bowels,  and  cold 
sweat  on  the  hands  and  feet.  It  may  be  employed  at 
the  first  dilution,  a  drop  every  half  hour,  until  a  de 
cided  impression  is  produced. 

Carbo  veg.  and  crotalus,  have  both  proved  cura 
tive  in  the  third  stage  of  yellow  fever,  and  should 
always  receive  due  attention  in  grave  cases. 


168 


CHAPTER  XVII. 

INFANTILE     REMITTENT. 

THIS  is  a  disease  peculiar  to  childhood,  and  is  usu 
ally  caused  by  the  use  of  unhealthy  and  indigestible 
food,  the  irritation  of  teething,  worms,  repelled  erup 
tions,  sudden  drying  up  of  ulcers,  discharges,  &c. 
The  affection  is  characterized  by  prominent  disorder 
of  the  stomach  and  intestines,  in  most  instances,  but 
occasionally  the  brain  or  lungs  seem  to  be  chiefly 
affected.  In  all  cases,  however,  whichever  part  the 
disease  may  seize  upon,  there  occur  regular  remissions 
and  exacerbations. 

Diagnosis. — The  malady  under  consideration  makes 
its  appearance  with  the  premonitory  symptoms  of 
ordinary  fever,  as  slight  chills,  restlessness,  thirst,  and 
wandering  pains  in  the  back,  bowels,  and  limbs. 
When  the  hot  stage  is  fully  developed,  the  patient  re 
fers  most  of  his  sufferings  to  the  stomach  and  intes 
tines  :  they  become  painful,  tender  upon  pressure,  and 
there  is  either  obstinate  constipation  or  diarrhoea.  The 
evacuations  are  usually  darkish,  offensive,  and  indi 
cative  of  a  deficiency  of  bile.  When  the  disease  is 
concentrated  in  the  stomach,  there  is  burning  thirst, 
with  vomiting  of  liquids  as  soon  as  swallowed  ;  the 
tongue  is  usually  covered  with  a  moist,  whitish  fur, 
and  red  at  the  edges.  If  the  inflammation  be  not 
promptly  arrested,  but  is  permitted  to  progress  with 
out  the  aid  of  appropriate  remedies,  lesions  will  occur 
in  the  digestive  tube,  or  disorder  of  the  brain  or  lungs 
will  be  very  likely  to  supervene. 

Causes. — Undue  exposure  to  cold,  sudden  changes 
of  temperature,  improper  food,  worms,  teething,  re 
pelled  eruptions,  abrupt  suppression  of  accustomed 
discharges,  and  the  injudicious  use  of  irritating  medi 
cines. 

Therapeutics. — The  remedies  suitable  for  the  treat 
ment  of  this  affection,  are,  in  the  first  instance,  the 
higher  dilutions  of  aconite,  followed  bv  those  medi- 


INFANTILE    REMITTENT.  169 

cines  which  accord  with  the  peculiar  symptoms  of 
each  case.  As  soon  as  the  fever  has  been  sufficiently 
subdued  by  the  former  medicine,  some  of  the  following 
articles  may  be  resorted  to  with  advantage  :  ipecacu 
anha,  cina,  chamomila,  mercurius,  belladonna,  arsenicum, 
pulsatilla,  nux  vomica,  spigelia,  sulphur. 

Since  in  most  instances  the  gastro-intestinal  mu 
cous  membrane  is  the  seat  of  the  malady,  it  will  be 
necessary  to  make  a  free  use  of  ipecac.,  mere.,  puls., 
mix,  cham.,  dulc.  Should  the  brain  or  lungs  become 
involved,  belladonna,  bryon.,  nux,  opium,  and  stramon., 
will  prove  efficient  remedies. 

Dr.  Drysdale  has  found  this  fever,  as  it  occurs  in 
England,  exceedingly  intractable,  notwithstanding  the 
most  assiduous  care  and  attention  on  the  part  of  both 
physician  and  friends.  In  children  of  scrofulous  con 
stitutions,  Dr.  D.  has  known  the  disease  to  persist  for 
months,  in  spite  of  every  remedial  measure.  In  cases 
of  this  description,  he  advises  sulphur,  calcarea,  arse 
nicum,  and  silicea. 

In  highly  impressible  and  irritable  children,  we  have 
often  witnessed  an  almost  constant  tendency  to  febrile 
attacks,  during  dentition.  The  alimentary  canal,  the 
brain,  and  the  nervous  system,  appear  to  remain  in 
such  a  condition  of  erethism,  that  the  slightest  exciting 
causes,  as  errors  in  diet,  worms,  suddenly  checked  per 
spiration,  &c.,  serve  to  develop  the  affection.  In  in 
stances  of  this  kind,  aconite,  belladonna,  and  chamomela 
are  peculiarly  appropriate,  and  will  generally  enable 
us  to  subdue  permanently  this  morbid  excitability. 
These  remedies  should  be  given  in  drop  doses  of  the 
twelfth  to  the  sixteenth  dilution,  once  in  twelve  hours, 
until  every  sign  of  undue  irritability  has  disappeared. 
Hartmann  commends  a  few  doses  of  coffea  cruda,  or  of 
col.  carb.  when  this  erethism  is  obstinate,  and  has  con 
tinued  for  a  long  time. 

If  the  febrile  attack  has  already  made  considerable 
progress,  with  excessive  irritability  of  the  stomach, 
and  immediate  ejection  of  every  thing  which  enters  it, 
however  simple  ;  distention,  pain,  and  tenderness  of 
the  stomach  and  bowels  upon  pressure  ;  hot  and  dry 
skin  ;  burning  thirst ;  tongue  covered  with  a  whitish 
fur,  and  red  at,  the  edges  ;  great  restlessness  and  irri- 

8 


170  INFANTILE    KEMlTTENT. 

tability  ;  loathing  of  food  ;  dark,  yellow,  slimy,  or  green 
diarrhoea,  we  may  give  a  grain  of  the  third  trituration 
of  ipecacuanha,  or  a  drop  of  the  sixth  dilution  of  chamo- 
mela,  once  in  two  hours,  as  long  as  is  deemed  neces 
sary. 

If  the  disease  is  still  farther  advanced,  and  the  coun 
tenance  has  assumed  a  pale,  or  dingy,  sunken  and 
cadaverous  aspect  ;  dark  and  puffy  appearance  under 
the  eyes  ;  coldness  and  dryness  of  the  skin,  or  cold 
clammy  sweat  ;  burning  pains  in  the  stomach  and  in 
testines  ;  thirst ;  constant  nausea  ;  the  smallest  quan 
tity  of  food  or  drink,  increasing  the  burning  and  dis 
tress,  until  they  are  rejected  ;  watery  diarrhoea,  with 
smarting  and  tenesmus  ;  great  prostration  ;  frightful 
dreams,  anguish  and  uneasiness,  especially  at  night ; 
dark,  dry  and  trembling  tongue  ;  black  and  dry  lips  ; 
grinding  of  the  teeth,  we  should  employ  arsenicum  at 
the  twelfth  dilution — a  drop  in  a  teaspoonful  of  water 
every  two  hours,  until  the  requisite  effect  is  produced. 

When  in  addition  to  the  symptoms  enumerated 
above,  the  child  is  exceedingly  restless,  and  sensitive 
to  light  on  the  slightest  noise  ;  with  flushed  cheeks  ; 
red,  glistening  and  protruded  eyes  :  hot  head  ;  con 
stant  raising  of  the  hands  to  the  head  ;  rolling  of  the 
head  from  side  to  side  ;  sudden  starts  from  sleep,  with 
screams  ;  spasmodic  twitches  in  different  parts  ;  dila 
ted  or  contracted  pupils  ;  short  and  oppressed  respira 
tion,  we  should  administer  belladonna  at  the  twelfth 
dilution — a  drop  in  water,  every  two  hours,  until  a 
decided  impression  is  evident. 

When  the  fever  is  accompanied  by  obstinate  consti 
pation  ;  frequent  desire  to  urinate  ;  burning  heat  of  the 
whole  body  ;  morning  exacerbations  ;  rigidity  of  the 
limbs  ;  or  drawing,  contractive  sensations  through  the 
body  ;  occasional  spasms  ;  frequent  trembling  both 
sleeping  and  after  an  exertion  ;  shudderings  and  chills 
from  the  least  contact  of  cold  air  ;  great  sensitiveness 
of  the  whole  body  ;  unpleasant  symptoms  often  ex 
cited  by  motion  or  contact  ;  and  indications  of  gastric 
or  bilious  disorder,  we  may  employ  nux  vom.  at  the 
twelfth  dilution — a  drop  in  water,  every  two,  three,  or 
four  hours,  as  circumstances  require. 

When  the  malady  has  been  caused  bv  the  irritation 


INFANTILE    REMITTENT.  171 

of  worms,  it  will  be  necessary  to  use  cina  or  spigelia. 
These  medicines  may  be  employed  at  the  third  attenua 
tion,  and  a  dose  given  three  or  four  times  daily  until 
the  morbid  disposition  of  the  alimentary  canal  is  cor 
rected. 

Bryonia  is  applicable  in  cases  attended  with  disor 
der  of  the  pulmonary  tissues.  In  addition  to  biliary 
and  gastric  derangement,  there  should  be  dry  racking 
cough  ;  stitches  in  the  chest  and  sides  ;  painful,  anxious, 
and  hurried  respiration  ;  bruised  pains,  and  soreness 
in  the  limbs  ;  pains  aggravated  by  motion  or  contact  ; 
hot  skin  ;  thirst ;  alternating  heat  and  chills  ;  nightly 
delirium  ;  irritable  and  quarrelsome.  This  remedy 
may  be  used  at  the  sixth  dilution — a  drop  once  in  two 
to  four  hours. 

Dulcamara  is  the  specific  when  the  fever  can  be 
traced  to  exposure  to  wet  and  cold,  which  has  caused 
a  sudden  check  to  the  perspiration.  In  these  cases, 
the  force  of  the  disease  is  expended  upon  the  mucous 
membranes  of  the  digestive  and  respiratory  organs,  as 
is  indicated  by  watery  diarrhoea,  pains  in  the  stomach 
and  bowels,  oppression  at  the  chest,  dry  coryza,  cough, 
and  difficult  respiration.  Its  administration  is  the 
same  as  bryonia. 

If  the  attack  is  attributable  to  abuse  of  fat,  crude 
and  indigestible  food,  and  is  accompanied  with  promi 
nent  gastric  derangement,  pulsatilla  should  be  em 
ployed  at  the  sixth  dilution — a  drop  every  four  hours 
until  the  disturbance  is  corrected. 


CHAPTER    XVII. 

CONTINUED    FEVER, 

In  this  class  of  fevers  may  be  included  those  aris 
ing  from  functional  derangement,  from  inflammation, 
from  congestion,  and  typhus. 

FEVER  FROM  FUNCTIONAL  DERANGEMENT. 

Diagnosis. — This  is  generally  the  mildest  and  least 
dangerous  of  all  the  continued  fevers.  It  commences 
with  slight  chills,  alternating  with  flushes  of  heat, 
lassitude,  restless  nights,  wandering  pains  in  the  head, 
back  and  limbs,  which  are  soon  succeeded  by  in 
creased  action  of  the  heart  and  arteries,  dry  and  hot 
skin,  thirst,  furred  tongue,  scanty  and  high-coloured 
urine,  and  moderate  derangement  of  almost  every 
function.  If  the  malady  is  met  at  the  onset  with 
suitable  remedies,  its  progress  is  cut  short,  and  imme 
diate  convalescence  ensues  ;  but  if  it  be  allowed  to 
continue  unopposed,  although  it  occasionally  subsides 
spontaneously,  it  generally  terminates  in  one  of  the 
other  forms  of  continued  fever. 

Causes. — Overloading  the  stomach  with  fat,  crude, 
and  indigestible  food,  insufficient  clothing,  irregular 
habits,  dwelling  in  damp  and  ill-ventilated  houses, 
and  the  habitual  and  intemperate  use  of  coffee,  tea, 
and  tobacco. 

Therapeutics. — Aconite,  from  the  first  to  the  third  dilu 
tion,  if  administered  early,  is  sufficient  to  cure  most 
cases  of  this  form  of  fever ;  but  if  the  disorder  is 
neglected  until  inflammation  or  congestion  occurs  in 
some  structure,  then  those  medicines  which  operate 
specifically  upon  the  parts  affected,  are  to  be  em 
ployed,  selecting  those,  of  course,  the  pathogenetic 
symptoms  of  which  cover  the  most  perfectly  those  of 
the  malady. 


CONTINUED    FEVER.  173 


FEVER  FROM  INFLAMMATION. 

Diagnosis.  —  In  this  form  of  fever  the  general  symp 
toms,  as  hot  and  dry  skin,  rapid  and  full  pulse,  dys 
pnoea,  thirst,  nausea,  oppression  at  the  epigastrium, 
restlessness,  furred  and  dry  tongue,  are  present  ;  but 
the  symptoms  which  more  particularly  characterize 
the  disease,  are  determined  by  the  organ  which  is 
prominently  affected. 

When  the  inflammation  is  located  in  the  mem 
branes  of  the  brain,  the  face  becomes  flushed,  the 
eyes  red  and  sparkling  or  protruded,  staring,  and  dis 
torted,  the  carotids  throb  violently,  pupils  contracted 
or  dilated,  expression  unnatural,  furious  delirium, 
pulse  full,  rapid,  and  bounding,  and  finally  if  the  dis 
order  progresses,  sopor,  muttering  delirium,  subsultus 
tendinum,  and  convulsions. 

If  the  disease  attacks  the  lungs,  we  shall  have  ra 
pid,  anxious,  and  oppressed  respiration,  shooting  pains 
in  the  thorax,  troublesome  cough,  with  difficult  ex 
pectoration,  pain  and  soreness  during  inspiration,  and 
perhaps  other  symptoms  pertaining  to  inflammation 
of  the  pulmonic  structures. 

If  the  gastro-intestinal  membrane  be  affected,  we 
shall  have  the  signs  peculiar  to  inflammation  of  this 
tissue,  as  nausea  and  vomiting,  pains  in  the  bowels, 
increased  on  pressure,  tongue  red.  countenance  ex 
pressive  of  anguish,  thirst,  bowels  hot  and  swollen. 

Causes.  —  Atmospheric  vicissitudes,  extremes  of  cold 
or  heat,  errors  in  diet,  arid  over-exertion.  Inflamma 
tory  fever  often  succeeds  neglected  or  mismanaged 
fevers  from  functional  derangement,  especially  in 
cases  where  some  organ  has  been  previously  debili 
tated,  and  in  this  manner  rendered  susceptible  to  in 
flammatory  action.  Indeed,  it  is  probable  that  inflam 
mations  seldom  occur  in  parts  which  are  perfectly 
healthy  and  vigorous,  but  that  when  the  exciting 
causes  of  fever  operate  in  these  cases,  they  merely 
give  rise  to  slight  and  easily  remedied  functional  de 
rangements.  Whenever,  therefore,  any  structure  of 
the  organism  is  in  a  state  of  unnatural  irritation  or 
debility,  this  constitutes  a  powerful  predisposing 
cause  of  inflammatory  fever,  which  only  requires 


174  CONTINUED    FEVER. 

> 

some  farther  morbific  influence  to  ensure  its  full  de 
velopment. 

Therapeutics. — As  in  this  form  of  fever  there  is  an 
exaltation  of  most  of  the  functions,  and  particularly 
of  the  circulatory  vessels,  aconite  is  an  indispensable 
remedy,  always  in  the  onset  and  frequently  during 
the  course  of  the  malady.  This  remedy,  as  all  are 
aware,  exerts  a  peculiar  power  over  the  action  of 
the  heart  and  arteries,  and  is,  therefore,  particularly 
appropriate  in  those  cases  distinguished  from  the 
first,  by  full  and  rapid  pulse,  hot  and  dry  skin, 
thirst,  <fec. 

In  those  instances  where  cerebral  disorder  predom 
inates,  belladonna,  opium,  and  stramon.0  will  be  found 
essential  in  the  treatment,  either  alone,  or  in  alter 
nation  with  aconite. 

If  the  pulmonary  tissues  are  inflamed,  suitable  re 
medies  may  be  found  in  bryon.,  tart,  ant.,  ipecac.,  and 
phosphorus. 

For  gastro-enteritic  inflammation,  recourse  .  must 
be  had  to  one  or  more  of  the  following  medicines, 
viz. :  mere.,  nux,  ipecac.,  puls.,  dulc.,  cham.,  ars.,  and 
verat. 

Administration. — In  the  selection  of  remedies,  much 
depends  upon  "the  age,  sex,  temperament,  as  well  as 
the  peculiarities  of  each  particular  case.  For  chil 
dren  and  adults  who  are  very  impressible,  we  advise 
the  higher  potencies  ;  while  in  cases  of  vigorous  and 
unsusceptible  persons,  the  very  lowest  attenuations 
will  prove  most  efficient. 

In  regard  to  the  repetition  of  doses,  no  definite  rules 
can  be  prescribed  beforehand  ;  everything  must  of 
necessity  depend  upon  the  nature  and  violence  of  the 
disease,  and  the  effect  which  each  particular  dose 
produces. 

FEVER    FROM    CONGESTION. 

Diagnosis. — The  precursory  stage  of  congestive 
fever  is  characterized  by  restlessness,  irritability,  in 
disposition  to  mental  or  bodily  exertion,  fatigue  from 
the  slightest  exercise,  vertigo,  giddiness,  apprehension, 
pulse  often  below  the  natural  standard.  This  stage 
continues  from  a  few  hours  to  six  or  seven  days,  when 
the  second  period  fully  developes  itself. 


CONTINUED    FEVER.  175 

The  symptoms  will  now  be  modified  in  accordance 
.with  the  organ  which  sustains  the  violence  of  the 
attack.  If  the  brain  be  the  suffering  structure,  the 
patient  will  complain  of  headache,  oppression  or 
tightness  in  the  head,  pupils  contracted  or  dilated,  the 
ideas  confused,  the  pulse  slow  and  labouring,  and, 
finally,  coma,  paralysis,  and  convulsions  may  super 
vene. 

When  the  bowels  are  the  seat  of  the  congestion, 
we  shall  observe  an  anxious  and  distressed  expression 
of  countenance,  eyes  sunken  and  glazed,  more  or  less 
nausea  and  vomiting,  bowels  burning  hot,  and  tender 
on  pressure,  while  the  extremities  are  cold ;  tongue 
slightly  coated  with  a  whitish  or  reddish  fur  ;  uneasi 
ness,  with  constant  desire  to  change  position  ;  frequent 
sighing;  bowels  constipated  or  relaxed;  and,  finally, 
spasms  and  stupor,  with  stertorous  breathing. 

If  the  disease  concentrates  in  the  lungs,  there  will 
be  rapid,  laborious,  and  obstructed  respiration  ;  pulse 
irregular  or  intermitting  ;  cough  ;  face  and  skin  pur 
ple  from  imperfect  decarbonization  of  the  blood ;  sur 
face  cold,  and  pains  in  the  chest. 

In  all  of  these  varieties  of  congestion,  the  physical 
and  mental  energies  of  the  system  are  below  the 
natural  standard,  the  pulse  is  generally  unusually  slow 
and  feeble,  the  function  of  the  lungs  is  imperfectly 
executed,  there  is  an  unequal  distribution  of  heat,  and 
diminution  of  sensibility  throughout  the  body. 

Causes. — Excessive  cold,  atmospheric  changes, 
drinking  large  quantities  of  cold  water  when  the  body 
is  heated,  insufficient  clothing,  improper  food,  severe 
mental  or  physical  exertion,  sudden  news,  grief,  fear, 
depression,  disappointment,  mortification,  &c. 

Therapeutics. — The  remedies  which  have  been  used 
with  most  success  in  congestive  fever,  are,  for  the 
cerebral  form,  bell.,  aeon.,  op.,  stram.,  hyos.,  conium 
mac.,  coff.,  mosch.,  and  camph. 

For  the  abdominal  form,  ipecac.,  verat.,  ars.,  nux, 
cuprum,  mere.,  phos.,  carb.  v.,  secale  cor. 

For  the  pulmonary  form,  bryon.,  aeon.,  phos.,  lack., 
seneg.,  rhus  tox.,  tart,  em.,  hyos.,  ammon.  carb. 

Administration. — Congestive  fevers  often  attack  the 
organism  suddenly  and  violently,  and  if  not  promptly 


176  TYPHUS. 

arrested,  run  on  to  a  speedy  and  fatal  termination. 
In  severe  cases,  therefore,  as  soon  as  the  remedy  has 
been  selected  which  is  homoeopathic  to  the  malady, 
it  should  be  repeated  at  short  intervals  until  a  decided 
impression  is  made  upon  the  symptoms.  After  a  rea 
sonable  time,  if  no  effects  are  apparent,  give  a  still 
stronger  dose,  or  change  the  medicine. 

Let  it  be  remembered,  in  all  violent  maladies, 
that  our  object  is,  to  produce  a  specific  effect  upon 
the  diseased  structure  as  soon  as  possible,  in  order 
that  we  may  supersede  the  morbid  by  a  healthy  medi 
cinal  action.  We  need  have  no  fear  in  this  fever  of 
creating  too  great  a  medicinal  aggravation,  for  there 
is  a  low  grade  of  erethism  and  impressibility  of  the 
whole  organism,  and  we  can  readily  apply  an  anti 
dote  to  any  over-action  which  may  be  excited,  and 
thus  control  its  influence,  while,  if  we  permit  the 
natural  affection  to  make  progress  from  a  too  timid 
and  sparing  an  exhibition  of  remedies,  disorganization 
will  be  likely  to  ensue. 

In  this  form  of  fever,  we  generally  employ  the  first, 
second,  and  third  attenuations, — the  dilutions  in  drop, 
and  the  triturations  in  grain  doses. 


CHAPTER  XVIII. 

LTYPHUS. 

Few  diseases  have  attracted  more  attention  and 
been  the  cause  of  more  bitter  controversies  in  the 
medical  world,  than  typhus  fever.  While  some  have 
maintained  that  it  is  a  malady  peculiar  to  the  cold 
seasons  of  temperate  latitudes,  and  caused  by  exhala 
tions  of  animal  or  vegetable  matters  in  a  state  of  pu 
trefaction,*  others  assert  with  equal  confidence  that  it 
occurs  in  all  climates,  at  all  seasons,  at  every  period 
from  infancy  to  old  age;  and  that  it  does  not  arise 

*  Dewees,  Bancroft,  <fcc. 


TYPHUS.  177 

from  any  specific  cause  (sui  generis),  but  may  proceed 
from  marsh  miasms,  animal  exhalations,  intense  cold, 
errors  in  diet,  over-exercise,  and  a  variety  of  other 
causes.*  Some  suppose  it  contagious,  and  others  non- 
contagious. 

Respecting  its  nature  and  seat,  it  has  had  the  hon 
our  of  being  located  by  different  medical  writers  in 
every  part  of  the  body,  from  the  crown  of  the  head 
to  the  soles  of  the  feet.  At  one  time  the  whole 
world  placed  it  in  the  blood  :  then  another  generation 
of  theorists  arose  who  seated  it  in  the  solids :  at 
another  period  all  the  world,  of  France,  made  the  dis 
covery  that  its  place  was  the  gastro-intestinal  mu 
cous  membrane,  and  that  Hippocrates,  Galen,  Celsus, 
Stahl,  Boerhaave,  Cullen,  Hoffman,  Brown,  et  omne 
id  genus,  had  been  labouring  under  a  succession  of  er 
rors  upon  the  subject  for  more  than  two  thousand  years. 
Still  later,  some  theorists  have  found  out  that  its  posi 
tion  is  in  the  brain  and  nervous  system,  while  a  few 
very  sensible  persons  have  arrived  at  the  conclusion 
that  the  exact  nature  and  seat  of  typhus  is  yet  involved 
in  obscurity. 

At  the  present  moment  there  are  a  great  variety  of 
opinions  respecting  it.  One  class  of  medical  men  sup 
pose  it  to  be  a  disease  affecting  principally  the  brain 
and  ganglionic  system  of  nerves.  Another  class  sup 
pose  its  action  to  be  in  "  the  mucous  membranes  and 
lymphatic  glands,  especially  those  of  the  ileum, 
whence  it  has  been  termed  typhus  abdominalis."-\ 
Others  still  suppose  it  to  be  a  disease  of  a  dynamic 
character,  or  an  affection  of  the  "vital  properties"  of 
the  system.  In  regard  to  this  last  supposition,  it  can 
not  be  refuted,  because  it  means  nothing  at  all.  It  is 
as  senseless  and  absurd  as  it  would  be  to  attribute  it 
to  a  derangement  of  the  electric,  magnetic,  galvanic, 
or  any  other  "  properties"  which  we  may  assume  that 
the  organism  possesses. 

The  malady  assumes  different  characteristics  ac 
cording  to  the  predisposition  of  the  individual  when 
exposed  to  the  influence  of  the  contagion.  If  his  sys- 

*  Naiham  Smith,  Macintosh,  <fec.         j-  Hartmann, 
8* 


178  TYPHUS. 

tern  has  been  debilitated  by  over-exertion  of  body  or 
mind,  by  grief,  care,  misfortune,  disappointment  or 
shame,  the  brain  and  nervous  system  will  be  promi 
nently  affected,  and  we  shall  be  presented  with  that 
variety  termed  cerebral  typhus. 

Should  the  stomach  and  intestines  happen  to  be  in 
a  state  of  irritation  and  debility,  when  the  contagion 
is  absorbed,  they  will  receive  the  impression,  and  we 
shall  have  what  is  denominated  abdominal  typhus. 

If  the  organ  predisposed  be  the  lungs,  the  morbific 
agent  will  spend  its  effects  at  this  point,  and  pneumo 
typhus  be  the  result. 

So  long,  however,  as  the  \vhole  organism  remains 
in  a  perfectly  sound  and  vigorous  condition,  with  the 
mind  cheerful  and  moderately  active,  it  will  be  able 
to  resist  the  influence  of  the  miasm,  and  in  all  proba 
bility  escape  the  malady.  The  law  is  fundamental, 
and  cannot  be  too  often  inculcated,  that  just  in  propor 
tion  as  the  organism,  or  any  part  of  it,  diverges  from 
the  normal  standard,  in  the  same  ratio  wrili  the  sus 
ceptibility  of  such  affected  structures  to  morbific  or 
remedial  influences,  be  increased. 

Diagnosis. — The  symptoms  which  appear  at  the 
commencement  of  typhus,  are,  lassitude,  debility, 
sense  of  fatigue,  impaired  memory,  slight  chills,  alter 
nating  with  flushes  of  heat,  dull  pains  in  the  head, 
back  and  limbs,  loss  of  appetite,  and  melancholy. 
These  symptoms  often  continue  one  or  two  weeks,  the 
patient  not  feeling  sick  enough  to  take  his  bed,  or 
sufficiently  well  to  attend  to  his  occupation,  when  he 
becomes  more  restless  during  the  night,  delirium  sets 
in,  he  is  obliged  to  keep  his  bed  from  debility,  his 
tongue,  which  was  at  first  coated  with  a  thin,  white 
fur,  becomes  dark,  dry,  and  cracked, and  as  the  disease 
advances,  the  old  fur  passes  off,  leaving  the  surface 
red,  glazed,  and  dry.  As  the  disease  progresses,  the 
eyes  become  suffused,  the  countenance  loses  its  natu 
ral  expression,  the  muscles  are  weak  and  tremulous, 
a  viscid  saliva  is  secreted,  which  collects  and  dries 
upon  the  lips  and  teeth,  the  surface  acquires  a  dingy 
colour,  there  are  subsultus  tendinum,  defective  vision, 
partial  loss  of  hearing,  a  tendency  to  slide  down  to 
the  foot  of  the  bed,  involuntary  discharges  from  the 


TYPHUS. 

bowels  and  bladder,  picking  at  the  bedclothes,  low 
muttering  delirium,  and,  finally,  coma,  convulsions 
and  death. 

The  symptoms  and  course  of  the  complaint  will,  of 
course,  be  modified  in  accordance  with  the  severity  of 
the  attack,  the  part  affected,  and  the  plan  of  treat 
ment  pursued. 

If  we  may  be  allowed  to  judge  from  the  opinions 
which  have  from  time  to  time  been  expressed  by  some 
of  the  eldest,  most  experienced,  and  distinguished 
members  of  the  old  school,  upon  this  subject,  we 
will  say,  that  the  course  of  treatment  ordinarily  re 
commended  and  pursued  by  allopathists,  is  productive 
of  far  more  injury  than  benefit,  in  typhus.  In  proof 
of  this,  we  quote  from  a  monograph  upon  typhus 
fever,  by  the  late  Professor  Nathan  Smith,  of  Yale 
College,  published  in  183L 

After  commenting  upon  the  various  contradictory 
methods  of  treatment  advised  by  different  authors,  as 
the  antiphlogistic,  stimulant,  tonic,  derivative,  &c.,he 
asserts :  "  I  am  clearly  of  opinion,  that  we  had  better 
leave  the  disease  (typhus)  to  cure  itself,  as  remedies, 
especially  powerful  ones,  are  more  likely  to  do  harm 
than  good." 

In  another  place  he  declared  :  that  "  the  use  of  pow 
erful  means,  with  a  view  of  curing  this  disease,  is 
liable  to  do  great  mischief." 

These  are  not  the  hasty  opinions  of  a  mere  theoret 
ical  man  of  books,  but  tKey  are  the  matured  senti 
ments  <jf  one  who  enjoyed  an  immense  practice  in 
several  of  the  different  New  England  states,  for  a 
period  of  more  than  forty  years.  Many  other  more 
recent  authors  have  not  hesitated  to  avow  similar 
views,  and,  although  they  do  not  yet  admit  the  truths 
of  the  new  law  of  cure,  they  entertain  an  entire  lack 
of  confidence  in  the  therapeutical  doctrines  of  the  old 
system,  so  far  as  typhus,  and  many  other  maladies,  are 
concerned. 

It  may,  then,  with  much  propriety  be  affirmed,  that 
serious  injury  is  often  inflicted  in  typhus  by  allopathic 
treatment,  and  that  many  of  the  symptoms  above 
-enumerated  are  aggravated,  if  not  actually  superin 
duced,  by  blood-letting,  counter-irritants,  and  power 
ful  drugs. 


180  TYPHU?. 

Causes. — The  presumption  is  very  strong,  that  the 
cause  of  typhus  is  a  specific  agent,  sui  generis,  and 
that  it  is  set  free  from  the  animal  body  during  the 
course  of  a  fever,  or  when  a  number  of  individuals 
are  crowded  together  in  close,  filthy,  and  ill-ventilated 
apartments.  This  specific  poison  rarely,  if  ever, 
makes  a  serious  impression,  unless  the  organism  is 
previously  predisposed  to  its  influence.  When  all  of 
the  organs  are  in  a  normal  condition,  and  operate  in 
a  healthy  manner,  an  equilibrium  is  maintained 
throughout  the  system  which  enables  it  to  resist  the 
action  of  noxious  agents.  The  ideas  which  we  have 
here  advanced  in  regard  to  the  specific  nature  of  ty 
phus  contagion,  were  maintained  by  a  number  of 
medical  men  many  years  ago,  amongst  whom  may  be 
named  the  distinguished  gentleman  to  whom  we  have 
before  alluded,  Dr.  Nathan  Smith. 

The  reasons  adduced  by  this  careful  observer  of 
nature  in  support  of  his  opinion,  are  as  follows  :  "On 
the  Connecticut  river,  for  two  hundred  miles  from 
north  to  south,  and  on  all  its  tributary  streams  on  both 
sides,  for  an  hundred  miles  in  width,  there  has  been 
no  instance  of  any  person's  having  contracted  the  in 
termitting  fever,  from  the  first  settlement  of  the  coun 
try  to  the  present  time  ;  and  yet  the  typhus  fever  has 
prevailed,  more  or  less,  in  every  township  within  that 
tract  of  country." 

If,  as  many  writers  assert,  the  miasms  of  intermit 
tent,  yellow,  and  typhus  fevers  are  analogous,  should 
we  not  constantly  witness  these  maladies  running  into 
each  other,  or  assuming  indiscriminately  these  differ 
ent  forms  in  the  same  location  1 

But  a  still  stronger  reason  is  brought  forward  by 
Dr.  Smith  to  sustain  his  position  :  he  asserts  that 
"  there  is  a  remarkable  odour  arising  from  a  person 
affected  with  this  disease,  so  peculiar,  that  I  feel  as 
sured,  that  upon  entering  a  room  blindfolded,  where  a 
person  has  been  confined  for  some  length  of  time,  I 
should  be  able  to  distinguish  it  from  all  other  febrile 
affections.  This  is  an  additional  circumstance  in 
favour  of  the  existence  of  the  specific  cause  assigned 
above,  as  several  other  diseases  which  arise  from  con 
tagion  are  attended  by  an  odour  peculiar  to  each, 


TYPHUS.  181 

which,  when  once  fixed  in  the  mind,  enables  a  person 
to  recognise  their  presence  ever  after.  This  is  strong 
ly  evinced  in  smallpox,  measles,  malignant  sore  throat, 


It  is  also  a  fact  worthy  of  note,  and  one  which  bears 
strongly  upon  this  point,  that  typhus  fever  was  entire 
ly  unknown  to  the  savage  tribes  of  America,  previous 
to  the  settlement  of  the  whites  ;  and,  even  at  the  pre 
sent  time,  those  bands  which  have  not  been  contami 
nated  by  the  civilizing  aggressions  of  the  usurpers  of 
the  soil,  but  continue  their  wild,  roving,  active  and 
simple  modes  of  life,  are  not  at  all  subject  to  this 
fever.  The  moment,  however,  they  forsake  their  sim 
ple  and  primitive  customs,  and  adopt  our  dissipated 
and  enervating  habits,  enclosing  themselves  in  close, 
ill-ventilated,  and  heated  apartments,  and  stuffing 
themselves  with  spirits,  greasy  and  indigestible  food, 
coffee,  tea,  condiments,  and  tobacco,  they  become 
affected  with  contagious  and  miasmatic  disorders,  and 
often  die  in  great  numbers.  This  fact  goes  to  prove 
that  typhus  is  a  disease  pertaining  exclusively  to 
civilized  life,  and  that  it  requires  the  unnatural  and 
artificial  customs  and  habits  of  the  white  race  to  ensure 
its  generation. 

But  as  the  constituents  of  animal  and  vegetable 
substances  are  so  nearly  identical,  it  is  highly  proba 
ble  that  the  typhus  poison  may  also  arise  from  vege 
table  decomposition  in  close  and  heated  apartments. 
Of  one  thing  we  may  be  assured,  respecting  both  ani 
mal  and  vegetable  matters  :  that  when  decomposition 
occurs  in  dark,  damp,  and  confined  places,  a  far  more 
active  and  virulent  miasm  is  generated,  than  when 
the  same  substances  undergo  transformations  in  the 
open  air. 

Therapeutics.  —  In  the  management  of  inflammatory 
typhus,  the  liberal  use  of  cold  water,  both  internally  and 
externally,  will  be  found  highly  beneficial.  This  im 
portant  agent  has  been  hitherto  quite  too  much  over 
looked  in  the  treatment  of  fevers,  for  there  is  no 
doubt  of  its  immense  power  as  a  curative  agent, 
when  judiciously  employed.  This  is  by  no  means  a 
modern  remedy,  as  many  suppose,  but  its  frequent  use 
was  strenuously  recommended  and  actually  adopted 


182  TYPHUS. 

for  many  years,  by  one  of  the  most  eminent  and  suc 
cessful  *  physicians  of  New  England,  as  long  ago  as 
1796.  The  following  quotations  will  show  the  views 
then  entertained  respecting  this  agent. 

"  The  most  effectual  method  of  reducing  the 
temperature  of  the  body,  is  by  the  use  of  cold 
water,  which  may  be  taken  internally,  or  applied 
externally." 

"The  only  effectual  method  of  cooling  the  body 
in  these  cases  (hot  stage  of  typhus),  is  by  the  use  of 
cold  water  applied  externally ;  by  this  means  we  can 
lessen  the  heat  to  any  degree  we  please." 

"  The  method  which  I  have  adopted,  is  to  turn 
down  the  bed  clothes,  and  to  dash  from  a  pint  to  a 
gallon  of  cold  water  on  the  patient's  head,  face  and 
body,  so  as  to  wet  both  the  bed  and  body  linen 
thoroughly.  As  soon  as  the  linen  and  bed  clothes  are 
dry,  if  the  heat  returns  again,  the  water  should 
be  again  and  again  applied  until  the  heat  is  sub 
dued." 

We  are  aware  that  physicians  have  been  deterred 
from  the  free  external  use  of  cold  water  in  fevers, 
through  fear  of  aggravating  existing  inflammations, 
causing  metastases.  congestions,  &c.,  by  repelling  the 
blood  from  the  surface  to  the  internal  organs,  but  the 
danger  from  this  cause  is  purely  imaginary :  for  cold 
water,  externally  applied,  not  only  operates  by  ab 
stracting  the  superfluous  heat,  and  reducing  the  ani 
mal  temperature,  but  it  also  acts  as  a  tonic,  imparting 
tone  and  vigour  to  the  debilitated  and  relaxed  capil 
laries  in  which  the  morbid  action  is  supposed  to 
reside. 

In  slight  cases,  frequent  sponging  of  the  surface 
will  be  sufficient  to  accomplish  our  object ;  but  in  more 
severe  instances,  the  method  adopted  by  Prof.  Smith 
may  be  resorted  to. 

By  adopting  this  course  of  treatment,  while  at  the 
same  time  we  administer  appropriate  remedies,  the 
disease  will  run  a  milder  course,  and  most  of  those 
grave  symptoms  which  are  too  often  witnessed,  will 
be  absent.  It  has  been  a  question  whether  typhus 

*  Treatise  on  Typhus,  by  N.  Smith. 


TYPHUS.  183 

can  ever  be  cut  short  by  remedies ;  some  maintain 
ing  that  it  may  be  broken  up  in  the  first  stage,  while 
others  are  of  opinion,  that  it  must  have  its  course. 
Upon  this  point,  Dr.  Drysdale  observes  as  follows  : 
"  We  do  not  believe  it  possible  to  cure  typhus  ;  all 
we  can  do  is,  to  conduct  it  to  a  favourable  termina 
tion  by  carefully  watching,  and  curing  all  the  inter- 
current  affections  so  apt  to  appear  in  it,  by  judicious 
management.  At  the  same  time  we  have  always 
given  the  remedies  usually  recommended,  especially 
rhusy  bryonia  and  arsenicum  ;  and  we  believe  that  the 
convalescence  will  be  much  hastened  by  judicious 
treatment."  Dr.  D.  advises  the  use  of  brandy  and 
wine  in  addition  to  our  remedies  during  the  stage  of 
collapse  ;  "  especially  when  there  is  great  want  of  ani 
mal  heat,  and  the  pulse  is  very  quick  and  small,  at 
tended  with  much  trembling  of  the  hands  and  con 
stant  muttering  delirium." 

The  appropriate  medicines  will  be  determined  by 
the  form  which  the  malady  assumes,  and  the  exact  na 
ture  of  each  particular  case. 

TYPHUS    CEREBRALIS. 

Belladonna,  bryonia,  aconite,  opium,  and  rhus,  will 
cover  most  of  the  symptoms  which  are  ordinarily  pre 
sent  in  this  form.  The  following  are  the  indications 
for  these  medicines. 

Belladonna.  —  External  indications.  —  Countenance 
flushed  and  bloated  ;  eyes  red  and  sparkling,  or  dull  and 
turbid  ;  or  pale,  brownish  and  glassy;  wild  expression, 
stupid,  fixed,  or  wandering  look ;  visible  pulsation  of 
the  carotids ;  respiration  irregular,  short  and  quick, 
or  slow  and  deep  ;  pupils  contracted  or  dilated,  gene 
rally  immovable  ;  pulse  variable,  but  generally  quick 
and  resisting;  tongue  red,  moist  or  dry,  or  yellowish 
white ;  breath  offensive  ;  urine  brownish  or  red ; 
spasms;  distortion  of  the  face  and  eyes;  head  very 
hot,  while  the  extremities  are  cool. 

Physical  sensations.  —  Fulness  and  heavy  pain  in 
the  head  ;  vertigo  ;  dizziness ;  violent  throbbings  in 
the  head  ;  strong  pulsation  of  the  carotids,  and  ar 
teries  of  the  head  ;  double  vision,  sparks  before  the 


184  TYPHUS* 

eyes,  or  weak  sight ;  humming  in  the  ears ;  inflam 
mation  of  the  throat,  chest,  and  abdomen ;  pains, 
heaviness,  or  numbness  of  the  limbs ;  palpitation  of 
the  heart :  pressure  and  cramp-like  pains  in  the  sto 
mach  ;  dryness  of  the  mouth  ;  adypsia,  or  thirst ;  con 
tinued  watchfulness  or  lethargy ;  constipation,  or 
diarrhoea  with  tenesmus ;  constant  moaning. 

Mental  and  moral  symptoms. — State  of  mind  apa 
thetic  ;  or  irritability  of  temper ;  illusions  of  the  sen 
ses,  and  frightful  visions ;  or  gloomy,  suspicious ; 
constant  moaning,  or  drowsiness  ;  profound  coma. 

Administration. —  A  drop  of  the  third  dilution  in 
water  once  in  two  hours,  until  the  desired  impression 
is  produced. 

Remarks.  —  Belladonna  is  indicated  in  typhus,  pre 
senting  a  sub-synochal  character.  It  is  contra- 
indicated  in  great  depression  of  the  cerebral  and 
nervous  energy  ;  but  applies  in  vascular  and  nervous 
erethism. 

Bryonici.  —  External  indications.  —  Face  red,  burn 
ing,  and  swollen ;  eyes  red  and  swollen,  or  dull, 
glassy,  turbid,  or  sparkling  and  suffused  ;  dryness  of  the 
nose ;  groans ;  respiration  difficult,  short,  rapid,  anxious, 
or  sighing  ;  thick  and  tenacious  expectoration  ;  pete- 
chiae ;  mouth  dry ;  tongue  dry,  and  coated  with  a 
dirty  or  yellowish  fur;  lips  brown  and  dry;  trem 
bling  of  the  limbs,  and  appearance  of  great  weariness 
and  debility  ;  pulse  variable ;  urine  pale,  or  brownish 
and  without  sediment. 

Physical  sensations. — Fulness,  heaviness,  and  pres 
sure  in  the  head,  from  within  outwards,  worse  on 
movement ;  confusion  and  dull  pains  in  the  head  ;  ver 
tigo  ;  buzzing  in  the  ears  ;  dulness  or  acuteness  of 
hearing  ;  sensation  of  dryness  in  the  throat ;  profuse 
sweat  during  the  heat  ;  bitter,  sour,  or  putrid  taste  ; 
thirst ;  nausea  ;  hiccough,  or  pressure  at  the  stomach  ; 
constipation  ;  abdomen  inflated  ;  weariness  and  pains 
in  the  back,  loins,  and  limbs,  aggravated  by  motion  ; 
abdominal  pains ;  drowsy  during  the  day;  restless  in 
the  night,  with  delirium. 

Mental  and  moral  symptoms. — Irascibility  ;  passion  ; 
fear  of  the  future  ;  anxiety  ;  fear  ;  stupidity  ;  delirium, 


TYPHUS.  185 

with  raving  respecting  business  ;  visions  on  closing 
the  eyes. 

Administration. — Same  as  belladonna. 

Remarks. — Bryonia  is  applicable  in  the  cerebral  and 
abdominal  varieties,  and  in  typhoid  pneumonia,  es 
pecially  in  the  first  period  before  the  muscular  and 
nervous  strength  have  become  materially  depressed. 
After  the  system  is  reduced  to  a  certain  extent,  it  may 
be  alternated  with  one  of  the  other  remedies  with  be 
nefit.  Bryonia  may  often  follow  belladonna  with  pro 
priety. 

Aconite. — In  the  first  stages  of  this,  as  well  as  in 
most  other  maladies  in  which  there  is  excessive  action 
of  the  circulatory  vessels,  aconite  is  an  indispensable 
remedy.  Its  properties  and  uses  are  so  well  known, 
that  we  shall  add  nothing  respecting  it  in  this  place, 
excepting  a  simple  caution  to  the  inexperienced  prac 
titioner,  that  while  endeavouring  to  reduce  the  force 
of  the  general  circulation,  he  should  not  neglect  im 
portant  local  inflammations.  It  may  be  administered 
in  the  same  manner  as  belladonna. 

Opium. — External  indications. — Face  dark  red,  or 
brownish,  hot  and  bloated  ;  pupils  dilated  and  immov 
able  ;  lower  jaw  hanging  from  relaxation  ;  lethargy, 
with  snoring  ;  mouth  and  eyes  open ;  irregular  and 
slow  respiration;  pulse  slow  or  suppressed;  bluish 
colour  of  the  skin  ;  convulsive  movements  of  the 
limbs ;  offensive  black  faeces ;  involuntary  evacu 
ations  ;  urine  scanty,  high  coloured,  depositing  a  brick- 
dust  sediment. 

Physical  sensations. — Sensation  of  great  heaviness 
in  the  head,  vertigo,  dizziness,  buzzing  in  the  ears  ; 
general  diminution,  or  entire  loss  of  sensibility  ;  cloudi 
ness  of  sight  ;  paralysis  of  the  tongue  ;  sensation  of 
weight  and  pulsations  in  the  stomach  and  abdomen  ; 
difficulty  in  evacuating  the  bladder  ;  great  oppression 
at  the  chest ;  hoarse,  dry  cough,  with  bloody  expec 
toration  ;  troublesome  itching  of  the  skin  ;  convul 
sions. 

Mental  and  moral  symptoms. — Stupor  ;  loss  of  con 
sciousness  ;  delirium ;  frightful  visions. 

Administration. — A  drop  of  the  third  dilution  in  an 
ounce  of  water — a  table  spoonful  once  in  two  hours. 


OF  THE 


186  TYPHUS. 

until  a  medicinal  aggravation  or  an  amendment  oc 
curs, — afterwards  repeat  according  to  the  exigencies 
of  the  case. 

Rhus  tox. — This  remedy  is  particularly  adapted  to 
the  nervous  forms  of  typhus,  and  may  often"  be  used 
with  advantage  in  cerebral  typhus  after  iryowici  or«c- 
onite,  or  in  ganglionic  typhus,  when  the  following  symp 
toms  present  themselves  : 

External  indication*. — Petechice  ;  face  red  and  swol 
len  ;  blue  circle  around  the  eyes  ;  nose  pointed  ;  lips 
dry.  brownish  or  black  ;  eyes  red,  with  viscid  secretion 
at  the  angles  ;  eyes  fixed  and  dull  ;  nose  dry,  swollen, 
and  tender  when  touched  ;  tongue  dry,  red,  or  dark  ; 
mouth  filled  with  viscid  mucus,  which  collects  upon 
the  teeth,  forming  sordes  ;  constipation  or  diarrhoea  ; 
teeth  white,  dry,  and  shining ;  colour  and  consistence 
of  faeces  variable  ;  retention  or  incontinence  of  urine  ; 
clear,  red,  or  turbid  urine  ;  paralysis  of  the  lower  ex 
tremities  ;  pulse  quick  and  small ;  coma,  with  snoring 
or  moaning. 

Physical  sensations  — Stupefaction  ;  vertigo ;  dizzi 
ness  ;  bruised  sensation  within  the  head ;  soreness  of 
the  scalp  ;  painful  oppression  in  the  stomach  ;  pulsa 
tions  in  the  epigastric  region  ;  spasms  and  pinchings 
in  the  abdomen  ;  pains  in  different  parts  as  if  from  a 
bruise,  worse  during  repose,  or  at  night,  and  relieved 
by  movement  ;  great  weakness  ;  tendency  to  faint- 
ness  ;  pain  and  difficulty  in  swallowing  ;  tenesrnus, 
with  loose,  slimy,  frothy,  sanguineous,  white,  yellow, 
or  red  evacuations  ;  constant  and  pressing  desire  to 
urinate  ;  oppression  at  the  chest,  with  difficult  respi 
ration  ;  soreness  in  the  limbs,  back,  and  neck,  when 
touched  or  at  rest ;  raw  feeling  in  the  throat  and 
chest ;  excessive  weakness,  tremblings,  sweats. 

Mental  and  moral  symptoms. — Muttering  delirium, 
or  coma  somnolentum,  with  snoring ;  anguish  and 
dejection  in  the  evening  and  at  night ;  inclination  to 
weep  ;  fear  of  death  ;  frequent  sighing. 

Administration. — A  drop  of  the  first  dilution  in  an 
ounce  of  water  :  a  dessert  spoonful  every  two  or  four 
hours.  If  no  decided  effect  ensues  after  a  reasonable 
time,  give  a  drop  of  the  mother  tincture  in  a  table- 
spoonful  of  water,  repeating  as  may  be  necessary. 


TYPHUS.  187 

Mcrcurius  vivus  has  been  successfully  employed  in 
cases  where  there  is  great  weakness,  rapid  sinking  of 
strength,  profuse  perspiration,  fainting  fits,  trembling 
and  numbness  of  the  limbs,  cramps,  and  convulsive 
movements,  great  agitation  and  uneasiness  of  body 
and  mind. 

PNEUMO    TYPHUS. 

The  medicines  which  have  proved  most  efficient  in 
this  form  of  typhus,  are,  aconite,  bryonia,  phosphorus, 
ammonia,  carb.,  acid  phosph.,  and  mcrcurius  viv. 

When  the  affection  is  characterized  by  accelerated 
circulation,  great  heat  of  skin,  thirst,  difficult,  anxious, 
short  and  rapid  breathing,  with  painful  stitches  in  the 
chest  and  side  when  inspiring;  cough  on  motion; 
lull,  hard,  and  rapid  pulse,  aconite  should  be  exhibited. 
A  dose  of  the  third  dilution  every  hour  or  two,  until 
an  impression  is  made  upon  the  symptoms. 

After  aconite  has  been  administered,  and  symptoms 
remain  unsubdued,  it  will,  be  necessary  to  resort  to 
some  of  the  following  remedies,  the  indications  for 
which  we  proceed  to  describe. 

Bryonia. — External  indications. — Same  as  under 
cerebral  typhus.  -4. 

Physical  sensations. — Confusion,  fulness,  heaviness, 
and  swimming  in  the  head  ;  headache,  aggravated,  by 
movement  or  opening  the  eyes  ;  respiration  difficult, 
short,  anxious,  rapid,  or  sighing  ;  oppression  of  the 
chest  ;  stinging  in  the  chest  when  coughing,  or 
breathing  deeply.  Shooting  pains  in  the  chest, 
side,  and  abdomen ;  pains  in  the  limbs  on  movement ; 
nose  swollen,  dry,  and  painful  to  the  touch  ;  throat 
dry,  with  sharp  pains  when  touched  or  in  motion  ; 
nausea  and  oppression  at  the  stomach  ;  constipation 
and  diarrhoea  alternating,  the  one  in  the  night,  and 
the  other  during  the  day ;  urine  scanty  and  high 
coloured  ;  cough,  with  stingings  or  stitches  in  the 
chest  and  side,  with  yellowish  or  bloody  expectora 
tion,  or  pains  in  the  head  ;  shooting  pains  under  the 
left  shoulder-blade  when  coughing  ;  tongue  dry,  con 
tracted,  dark,  or  yellow ;  pulse  rapid  and  full,  or 
quick,  weak,  and  irregular. 


188  TYPHUS. 

Mental  and  moral  symptoms. — Same  as  under  cere 
bral  typhus. 

Administration. — Same  as  under  cerebral  typhus. 

Phosphorus. — External  indications. — Yellow,  brown, 
coppery,  or  bluish  spots  upon  the  skin  ;  viscid  secre 
tion  about  the  eyes,  particularly  at  night ;  quivering 
of  the  eyelids  ;  dryness  and  obstruction  of  the  nose ; 
face  pale,  dingy,  or  red  and  bloated  ;  eyes  sunken  and 
surrounded  by  a  dark  circle  ;  lips  dry  and  bluish ; 
ulcers  at  the  corners  of  the  mouth ;  tongue  with  a 
dry  and  dark,  or  whitish  fur  ;  respiration  irregular, 
laborious,  noisy,  or  panting ;  pulse  quick  and  hard. 

Physical  sensations. — Stunning  headache,  vertigo, 
and  dizziness,  worse  in  the  morning  ;  smarting  or 
burning  sensation  in  the  eyes  ;  throbbing  in  the  ears  ; 
deafness  ;  offensive  discharge  from  the  nose  ;  dryness 
and  raw  sensation  in  the  throat ;  nausea  and  pains 
in  the  stomach;  uneasiness  and  painful  contraction 
of  the  abdomen  ;  stitches  and  roughness  in  the  chest ; 
expectoration  of  mucus,  slimy,  sanguineous,  or  puru 
lent  matter  ;  sharp  pains  in  the  shoulder-blades  ;  stiff 
ness  of  the  neck  ;  trembling,  coldness,  and  numbness 
of  the  limbs  ;  great  oppression  at  the  chest,  with  dis 
tressed  and  anxious  respiration. 

Mental  and  moral  symptoms. — Despondency,  an 
guish,  and  fear,  especially  at  night ;  disposition  to 
weep  or  laugh. 

Administration. — A  drop  of  the  third  dilution  in  an 
ounce  of  water ;  a  dessert  spoonful  once  in  two  to 
six  hours,  until  an  effect  is  perceptible. 

Ammonium  carl).  —  External  indications.  —  Miliary 
eruptions,  or  redness  of  the  skin  ;  eyes  dry ;  nose  ob 
structed  with  dry  coryza ;  face  pale  and  bloated  ; 
lips  dry  and  dark-coloured  ;  faeces  in  small,  hard 
lumps ;  respiration  short  and  anxious  ;  breath  offen 
sive  ;  tongue  covered  with  slime  or  vesicles  ;  pulse 
weak  and  rapid. 

Physical  sensations. — Great  restlessness  at  night ; 
drowsy  during  the  day  ;  disturbed  sleep  at  night,  with 
frightful  dreams  ;  pains  in  the  head  ;  nausea  ;  ring 
ing  in  the  ears,  worse  at  night  ;  sensation  of  excori 
ation  in  the  mouth  and  throat ;  constant  thirst ;  con 
stipation  and  itching  at  the  amis  ;  frequent  desire  to 


TYPHUS.  189 

urinate  during  the  night ;  hoarse,  or  short  dry  cough, 
with  tickling  and  roughness  in  the  throat ;  mucous 
and  sanguineous  expectoration ;  sharp  pains  in  the 
chest  and  sides,  on  coughing,  breathing,  or  moving ; 
drawing  pains  in  the  nape  of  the  neck  and  small  of 
the  back  ;  extremities  stiff  and  numb  ;  cramps,  cold 
ness,  and  swelling  of  the  feet ;  excessive  weakness  of 
the  limbs  ;  right  side  worse  than  the  left. 

Mental  and  moral  symptoms.  —  Discouragement ; 
anxiety  ;  apprehension  ;  anguish  ;  sad,  weak,  timid  ; 
mental  distress,  worse  at  night. 

Administration. — A  grain  of  the  first  trituration 
every  two,  four,  or  six  hours,  as  the  nature  of  the  case 
requires. 

Acid  Phosphoric. — External  indications. — Eruption 
of  small  pimples  on  the  skin  ;  redness  of  the  skin  ; 
coma  ;  eyes  dull,  glassy,  fixed,  with  pupils  dilated ; 
coryza,  with  redness  of  the  nostrils  ;  face  pale,  or 
covered  with  pimples ;  teeth  yellow ;  gums  swollen 
and  bleeding ;  tongue  covered  with  thick  and  adhe 
sive  mucus ;  faeces  hard,  knotted,  and  slimy ;  urine 
clear  or  white,  depositing  a  white  sediment ;  pulse 
quick  and  weak. 

Physical  sensations. — Great  physical  and  mental 
prostration ;  pains  in  the  chest,  abdomen,  and  head, 
worse  during  repose,  relieved  by  motion  ;  head  con 
fused,  bewildered  with  pains  when  moving  it ;  eyes 
weak  and  sensitive  to  candle-light ;  music  painful  to 
the  ears  ;  cheeks  hot  and  burning ;  nausea  and  op 
pression  at  the  stomach ;  diarrhoea,  frequent  inclina 
tion  to  urinate  ;  tightness  and  oppression  in  the  chest ; 
cough,  with  purulent  expectoration  ;  sharp  pains  in 
the  chest ;  burning  sensation  in  the  hands  and  feet. 

Mental  and  moral  symptoms. — Indifferent  ;  taciturn  ; 
peevish  ;  stupid. 

Administration. — Suitable  in  some  cases  of  advanced 
pneumo  typhus.  A  dose  of  the  third  dilution  may  be 
given  once  in  four  to  six  hours. 

The  following  medicines  should  be  named  as  ap 
propriate  under  certain  circumstances,  in  pneumo 
typhus,  viz.,  lachesis,  tart.,  emet.,  senega,  mere.,  lobel. 
inflat. 


190  TYPHUS. 

TYPHUS  ABDOM1NALIS. 

From  the  close  analogy  of  appearances  produced 
upon  the  intestinal  canal,  by  fatal  doses  of  arsenicum 
and  by  fatal  abdominal  typhus,  it  would  be  a  natural 
conclusion  that  arsenicum  is  for  this  disease  a  valua 
ble  homoeopathic  remedy.  There  has  been,  however, 
a  wide  difference  of  opinion  upon  this  question,  be 
tween  some  of  our  most  eminent  practitioners.  Many, 
like  Hausmann,  Fleishmann,  Gumpendorf,  Staph, 
Jahr,  Henderson,  Laurie,  Currie,  and  Hartmann,  have 
eulogized  arsenicum  for  this  form  of  typhus,  in  the 
most  enthusiastic  manner  ;  at  the  same  time  a  very 
few,  as  Wurmb,  Lorentz,  &c.,  have  denied  that  it 
possesses  any  special  curative  properties  in  any  stage 
of  the  malady. 

But  the  weight  of  testimony  is  so  much  in  favour  of 
the  advocates  of  arsenicum- in  abdominal  typhus,  that 
we  shall  not  enter  into  any  discussion  of  the  question, 
but  simply  express  the  opinion,  that  in  all  cases  of  the 
genuine  forms  of  this  disease,  arsenicum,  when  exhibit 
ed  judiciously,  will  prove  a  remedy  of  immense  im 
portance.  Indeed,  we  believe  in  those  cases  of  ulcera- 
tion  of  the  mucous  membrane  of  the  ileum,  Peyer's 
glands,  &c.,  and  in  those  instances  where  the  blood  be 
comes  congested  in  different  parts  of  the  intestinal  ca 
nal,  giving  rise  eventually  to  sphacelation  if  unop 
posed,  that  arsenicum  is  a  specific  of  positive  and  de 
cided  power.  In  support  of  this  opinion,  we  refer 
with  full  confidence  to  the  numerous  hospital  and  pri 
vate  reports,  which  have  been  presented  to  the  public 
in  the  last  few  years. 

In  relation  to  the  cause  or  causes  of  the  ulcers  so 
often  discovered  by  the  Hippocratics  in  autopsieal  ex 
aminations  of  those  who  have  died  of  typhus  abdomi- 
nalis,  an  allopathic*  physician  of  forty  years'  standing 
in  Massachusetts,  makes  the  following  very  pertinent 
inquiries  in  a  late  number  of  the  Boston  Medical  and 
Surgical  Journal :  After  expressing  himself  as  "  fully 
persuaded  that  one  of  the  great  secrets  of  curing  pa 
tients  is  not  to  kill  them,"  he  proceeds  : — "  I  should  like 
to  be  informed  whether  there  is  not  danger  in  giving 

*  Silas  Brown,  M.  D. 


TYPHUS.  191 

inwardly,  in  any  quantity,  strychnia,  creosote,  prus- 
sic  acid,  nitrate  of  silver,  and  a  host  of  other  virulent 
caustic  poisons  ;  and  whether  some  of  them  \vouldnot 
have  a  tendency  to  cauterize  or  constringe  the  delicate 
absorbents  and  other  vessels  of  the  digestive  organs  ; 
and  whether  such  medicines  have  congeniality  or 
affinity  enough  with  the  membranous  and  vascular  por 
tions  with  which  they  come  in  contact,  to  become  sana 
tive  medical  agents  ;  or  whether  they  would  not  have 
a  tendency  to  produce  obstructions  mid  those  ulcers 
which  we  meet  with  in  the  post-mortem  examinations  of 
those  subjects  who  die  of  typhus  fever"  He  requests 
an  answer,  and  we  venture  the  suggestion  that  if  he 
adopts  an  affirmative  one,  he  will  be  in  little  danger 
•  of  error.  But  to  proceed  with  our  description  : 

Arsenicum. — External  indications. — Skin  dry  or  yel 
lowish,  or  cold  and  bluish  ;  reddish  or  dark  spots  on 
the  skin ;  petechiae  ;  eyes  dull,  glazed,  and  sunken  ; 
pupils  contracted  ;  face  shrunken,  ho!lo\v,  pale,  and 
cadaverous,  or  yellowish,  bluish,  or  leaden  coloured ; 
expression  of  countenance  distorted  and  unnatural  ; 
cold  sweat  on  the  forehead  ;  lips  dark,  dry,  and 
cracked  ;  teeth  dry,  white,  and  shining  ;  sordes  upon 
the  teeth  ;  tongue  dry,  shrivelled,  bluish  or  black,  with 
trembling  and  inability  to  protrude  it ;  faeces  variable, 
generally  loose,  darkish,  or  greenish,  and  fetid  ;  invol 
untary  discharges  of  faeces  and  urine  ;  urine  reddish, 
brownish,  yellow,  or  turbid  ;  tympanitis  ;  guggling 
noise  of  liquids  swallowed ;  respiration  short  and 
anxious ;  cramps  in  the  legs  ;  pulse  irregular,  or 
quick,  weak,  small,  and  frequent,  or  feeble  and  trem 
bling  ;  voice  sepulchral  and  tremulous ;  coma  or  low 
muttering  delirium;  trembling  of  the  limbs  ;  subsultus 
tendinum  ;  sometimes  deafness  ;  hippocratic  counte 
nance  ;  colliquative  sweats. 

Physical  sensations. — Extreme  debility  or  complete 
prostration  ;  burning  and  heat  at  the  pit  of  the  stomach 
and  epigastrium;  nausea,  and  vomiting,  especially 
after  eating  or  drinking  ;  violent  pains  and  burnings 
in  the  abdomen,  generally  on  the  left  side  ;  sometimes 
only  pain  on  pressure ;  pains  in  the  right  hypochon- 
drium  ;  stitches  in  the  side  with  anxious  and  difficult 
breathing :  universal  loss  of  strength,  and  excessive 


193  TYPHUS. 

restlessness ;  stools  dark,  greenish,  putrid,  fetid  and 
involuntary ;  head  painful,  weak,  confused,  as  if 
stunned  ;  distention  of  the  abdomen  ;  stiffness  of  the 
limbs. 

Mental  and  moral  symptoms.  The  patient  is  dis 
satisfied,  restless,  anxious,  discouraged  ;  or  muttering  ; 
delirious  ;  sleep  disturbed,  with  unpleasant  visions. 

Administration.  In  extreme  cases,  a  grain  of  the 
second  or  third  trituration  may  be  given  every  half 
hour,  gradually  lengthening  the  intervals  as  circum 
stances  require. 

Remarks.  Arsenicum  is  especially  serviceable  in 
the  third  stage  of  abdominal  typhus,  when  ulcers  have 
formed.  It  will  also  frequently  apply  in  the  second 
stage,  when  the  bowels  become  relaxed. 

Carbo  vegetabilis,  is  also  a  remedy  of  importance  in 
the  last  stages  of  abdominal,  and  in  all  stages  of  putrid 
typhus.  In  the  former,  it  may  sometimes  be  exhibited 
in  alternation  with  arsenicum,  with  good  effect.  The 
following  are  the  external  indications: — hippocratic 
countenance  ;  face  pale,  yellowish,  or  dingy  ;  eyes 
sunken  and  glazed,  with  nocturnal  agglutination  ;  lips 
dry  and  cracked ;  tongue  dry,  dark,  and  tremulous ; 
position  upon  the  back  ;  cold,  clammy  sweat  ;  pulse 
rapid,  trembling,  and  almost  imperceptible ;  trem 
blings  and  jerkings  of  the  limbs;  urine  red  and  high- 
coloured  ;  faeces  putrid  and  offensive. 

Physical  sensations. — An  entire  prostration  of  the 
animal  powers ;  heavy,  pressing,  or  drawing  pains  in 
the  head  ;  ulceration  and  bleeding  of  the  gums ;  rat 
tling  in  the  throat ;  cramp-like,  pressing,  or  burning 
pains  in  the  stomach  and  intestines  ;  burning  pains 
and  oppression  at  the  chest ;  rigidity,  or  complete  pa 
ralysis  and  relaxation  of  the  nape  of  the  neck  and 
limbs  ;  bowels  swollen  and  tender  on  pressure ;  feet, 
legs,  and  hands  cold  ;  numbness  of  the  limbs. 

Mental  and  moral  symptoms. — Coma,  or  sleepless 
ness,  with  muttering  delirium  ;  mind  dull,  confused, 
wandering,  or  stupid. 

Administration. — A  dose  of  the  third  trituration 
may  be  given  in  water,  every  half  hour,  in  extreme 
cases,  until  the  necessary  impression  is  made. 

Hartrnann  speaks  in  high  terms  of  staphijsagria  in 


TYPHUS.  193 

the  first  stage  of  the  disease,  when  the  following  symp 
toms  appear :  "  Sordes  on  the  teeth,  pale  and  bleed 
ing  gums,  with  painful  swelling  of  the  gums,  and  rapid 
decay  of  the  teeth  ;  vanishing  of  thoughts  and  ideas, 
weakness  of  memory,  dulness  of  mind,  great  indiffer 
ence  and  ill  humour ;  vertigo,  with  stupifying  head 
ache  ;  dimness  of  the  eyes,  itching,  stinging,  and  heat 
in  the  canthi  ;  fulness  in  the  pit  of  the  stomach,  with 
frequent  hiccough  and  vomiting ;  tension  across  the 
hypochondria,  oppressing  the  breathing  ;  pressure, 
weight,  and  tension  in  the  abdomen ;  cutting  pain  in 
the  bowels,  with  nausea ;  copious  diarrhosic  stools." 

Muriatic  acid  is  a  highly  important  remedy  in  many 
cases  of  advanced  typhus,  when  the  patient  is  stupid, 
unconscious  of  surrounding  occurrences,  and  extreme 
ly  prostrate.  Other  symptoms  are,  constant  tendency 
to  settle  down  towards  the  foot  of  the  bed,  low  mut 
tering  delirium,  groaning  in  sleep,  moaning,  picking  at 
the  bed-clothes ;  inability  to  protrude  the  tongue,  dry 
heat,  with  transient  and  partial  sweats,  general  unea 
siness,  "depression  of  the  lower  jaw,  digging  with  the 
head  into  the^pillow,  turning  up  of  the  whites  of  the 
eyes,  slavering,  &c."  (Hempel.)  We  may  employ  the 
first  to  the  third  dilution — a  drop  in  a  drachm  of  water, 
every  two  hours  as  long  as  necessary. 

Dr.  Kidd  found  phosphorus  a  valuable  remedy  in  the 
treatment  of  the  typhus  which  devastated  Ireland  dur 
ing  1847  and  48.  Rhus  tox\,  bryonia  and  arsenicum  are 
likewise  highly  commended  by  the  doctor,  when, 
"  from  the  very  commencement,  the  heat  of  skin  and 
acceleration  of  pulse  are  very  inconsiderable,  and  in 
the  middle  and  latter  stages,  are  almost  invariably  be 
low  the  natural  standard.  For  two  or  three  days  the 
patient  would  labour  under  lassitude  and  languor,  with- 
loss  of  appetite  and  of  sleep,  the  tongue  being  general 
ly  the  first  index  of  the  probable  mischief  in  store. 
About  the  fourth  or  fifth  day,  the  disease  being  generally 
well  marked,  with  a  very  slight  heat  of  skin,  which 
felt  soft  and  clammy,  being  covered  with  moisture, 
(not  like  the  ordinary  feel  of  a  perspiring  skin,  but  as 
if  the  skin  were  damped,  and  by  some  contrivance  all 
evaporation  prevented,)  the  pulse  very  little,  if  at  all 
altered,  except  in  strength,  which  even  at  this  period 


194  TYPHUS. 

would  be  somewhat  deficient  ;  the  tongue  presented 
a  most  characteristic  appearance  :  in  general  dry,  hard, 
and  glazed,  like  brown  leather,  or  deeply  covered  with 
brown  or  blackish  fur.  In  some  cases  it  appeared 
soft,  moist,  and  tremulous,  covered  with  a  perfect  and 
uniform  layer  of  pure  white  paste  or  mucus,  (this  in 
general  omened  a  very  severe  and  dangerous  form  of 
the  disease,)  the  gums  and  teeth  became  covered  with 
brownish  incrustations,  thirst  being  incessant  and  in 
satiable,  with  nausea  and  vomiting  ;  in  many  cases 
abdominal  symptoms,  as  tension  and  tympanitic  re 
sonance  of  the  abdominal  walls,  with  tenderness  and 
shooting  pain  over  either  iliac  region,  (in  general  the 
right  ;)  bowels  seldom  costive,  in  general  relaxed, 
with  or  without  pain  ;  urine  in  a  few  cases  suppressed, 
in  most  unchanged  ;  head  in  general  implicated :  in 
most  from  the  beginning,  with  aching  and  heaviness 
at  the  forehead,  throbbing  at  the  temples,  vertigo, 
sense  of  emptiness  and  bewilderment ;  delirium,  mostly 
at  night,  with  low  muttering,  or  with  stupid,  heavy 
insensibility,  and  incoherence  of  speech.  The  eyes 
appeared  dull,  inanimate,  and  listless,  with  the  head 
instinctively  turned  from  the  light.  In  a  few  cases, 
towards  their  termination,  a  peculiar  sort  of  stolid 
deafness  supervened,  which  gradually  disappeared  as 
convalescence  advanced. 

"  Almost  invariably  the  lower  extremities  were  com 
plained  of  as  being  dead  and  numbed,  rendering  the 
least  motion  impossible,  (but  without  any  actual  pain,) 
the  feet  and  legs  feeling  cold  and  damp. 

"  General  debility  and  prostration  set  in  early  in  the 
disease,  and  proved  the  most  obstinate  of  the  symp 
toms."* 

Dr.  K.  relied  upon  the  four  medicines  above  named, 
in  this  form  of  the  malady,  and  the  results  show  a 
mortality  of  less  than  two  per  cent.  His  success  in 
the  numerous  cases  of  continued  fever  which  came 
under  his  care,  was  no  less  gratifying.  The  low  di 
lutions  were  employed  for  the  most  part ;  but  in  a  few 
cases  drop  doses  of  the  tinctures  were  deemed  neces 
sary. 

*  Truths  and  their  Reception.  <fec.,  by  J.  Kidd,  M.  D.,  London,  1 849. 


TYPHUS.  195 

The  other  medicines  necessary  in  the  treatment  of 
certain  stages  of  this,  as  well  as  the  other  forms  of 
typhus,  are :  rhus  tox.,  acid,  nit.,  nux  vom.,  secale  cor., 
mere.,  op.,  camph.,  china,  nux  mos.,  valer.,  stram.,  hyos., 
and  lack.  These  remedies  will  all  occasionally  be 
called  into  requisition,  so  that  their  effects  upon  the 
human  system  should  be  well  understood  and  appre 
ciated. 

It  will  be  observed  that  we  have  divided  typhus 
into  but  three  varieties.  Other  authors  add  a  typhus 
putridus.  typhus  contagiosus,  typhus  lentus,  typhus  pe- 
techialis,  &c.  In  practice,  however,  we  seldom  find 
any  one  of  these  forms  distinct  and  unmixed  ;  but  the 
brain,  nervous  system,  lungs,  and  abdominal  viscera 
partake  more  or  less  in  the  general  disturbance,  caus 
ing  each  particular  case  to  present  peculiar  and  di 
verse  symptoms.  So  in  regard  to  the  treatment  of  this 
fever,  it  will  often  be  found,  from  its  commencement 
to  its  termination,  to  require  one  or  more  of  the  medi 
cines  which  we  have  placed  under  each  form  of  the 
malady.  The  sympathetic  connections  are  so  strongly 
pronounced,  between  the  important  organs  in  which 
the  different  varieties  of  typhus  are  located,  that  one 
cannot  be  affected  without  imparting  disorder  to  the 
ofliers. 

Physiologists  note  it  as  a  curious  fact,  that  no  two 
human  faces  are  exactly  alike,  and  it  may  be  asserted 
with  equal  safety,  that  no  two  instances  of  typhus 
fever  ever  presented,  from  first  to  last,  precisely  the 
same  symptoms.  Therefore  it  is,  that  in  all  cases  of 
this,  as  well  as  of  other  maladies,  we  must  trust  to 
symptoms  alone,  and  be  guided  by  them  in  the  appli 
cation  of  our  remedies,  rather  than  by  the  name  of  the 
disease.  Our  nomenclatures  and  classifications  un 
questionably  facilitate  the  investigations  and  diagno 
sis  of  complicated  cases,  but  they  can  be  of  very  little 
importance  in  the  practical  exhibition  of  medicines. 


196 


CHAPTER    XIX. 

HECTIC  FEVER. 

Diagnosis. — The  ordinary  symptoms  of  this  fever, 
are :  daily  febrile  paroxysms,  general  debility,  ema 
ciation,  skin  pale,  face  often  tinged  with  the  "  hectic 
flush,"  irritable  stomach,  loss  of  appetite,  moderate 
thirst,  night  sweats,  tendency  to  perspire  through  the 
day,  diarrhoBa,  pulse  quick,  small,  and  sharp. 

Causes.  —  The  combination  of  symptoms  denomi 
nated  hectic  fever,  in  most  cases,  proceed  from  long 
continued  and  profuse  suppuration ;  but  they  may 
arise  from  protracted  local  irritation  without  suppu 
ration.  Some  writers  suppose  that  hectic  can  only 
proceed  from  the  absorption  of  pus,  but  this  is  erro 
neous,  as  the  symptoms  of  hectic  often  make  their 
appearance  before  suppuration  occurs.  In  nearly  all 
instances,  it  is  a  secondary  affection  consequent  upon 
either  protracted  disease  in  some  vital  part,  some  of 
the  joints,  or  of  some  extensive  surface.  It  proceeds 
more  readily  from  diseases  of  the  "  bones,  ligaments, 
and  tendons,  than  from  those  of  the  muscles,  skin, 
cellular  membrane,  &c."  * 

It  may,  then,  be  considered  as  a  constitutional  dis 
turbance,  originated  and  kept  up  by  some  previous 
local  disease,  and  which  cannot  be  permanently  cured 
until  the  original  cause  upon  which  it  is  dependent,  is 
eradicated  or  removed. 

In  those  cases  where  it  is  kept  up  by  incurable  dis 
eases  of  the  joints,  bones  of  the  extremities,  or  other 
parts  which  can  be  safely  removed  by  the  surgeon, 
amputation  or  excision  should^be  at  once  resorted  to, 
and  the  hectic  symptoms  will  speedily  disappear. 
Mr.  Hunter  remarks,  that  "  a  hectic  pulse  at  one  hun 
dred  and  twenty  has  been  known  to  sink  to  ninety  in 
a  few  hours  after  the  removal  of  the  hectic  cause." 
Several  instances  have  occurred  in  my  own  practice, 
in  which  an  almost  immediate  and  entire  cessation 

*  Sir  A.  Cooper. 


HECTIC  FEVER.  197 

of  the  hectic  symptoms,  such  as  sleepless  nights, 
febrile  paroxysms,  night  sweats,  diarrhoea,  rapid  pulse, 
&c.,  has  resulted  from  amputation  or  excision  of  the 
offending  parts. 

When  the  original  cause  is  a  suppuration  of  some 
important  organ  like  the  lungs,  liver,  stomach,  &c., 
our  prognosis  must  generally  be  unfavourable.  In 
these  instances  it  is  of  the  utmost  importance  to  the 
homo30pathic  practitioner  that  he  makes  a  thorough 
investigation  of  all  remote  causes,  in  order  to  arrive 
at  an  accurate  knowledge  of  the  latent  and  original 
sources  of  the  malady.  He  will  thus  be  able  to 
direct  his  remedial  applications  with  judgment, 
and  afford  to  his  patients  the  only  possible  chance  of 
cure. 

Therapeutics. — In  the  selection  of  remedies,  every 
thing  must  of  necessity  depend  upon  the  original 
cause, — its  ?seat,  nature,  and  violence  ;  and  upon  the 
secondary  consequences  to  which  it  gives  rise.  It 
should  always  be  a  prime  object,  to  direct  our  most 
potent  remedies  with  perseverance  against  the  local 
affection ;  and  if  any  latent  or  apparent  influences 
exist,  against  these  also. 

If  we  are  called  to  a  case  of  hectic  fever,  proceed 
ing  from  an  inflammation  of  a  scrofulous  character, 
advantage  will  be  derived  from  the  use  of  some  of 
the  following  medicines :  sulphur,  aurum  mur.,  calca- 
rea,  china,  iodine,  oL  jecor.,  aseL,  acid,  nit.,  acid,  mur., 
acid.phos.,  phos.,arsenicum,  silicea,  and  mercurius. 

In  cases  proceeding  from  syphilitic  or  mercurial 
diseases  ^f  the  bones,  ligaments,  &c.,  the  medicines 
adapted  to  the  cure  of  these  disorders  should  be  se 
lected. 

If  a  chronic  miasm,  whether  psoric  or  otherwise, 
has  originated  the  disturbance,  then  strike  deeply  at 
the  original  cause  with  antipsorics,  as  well  as  at  pre 
sent  symptoms,  and  good  results  may  accrue  in  appa 
rently  desperate  cases. 


198 


CHAPTER   XX. 

OF  THE  FEBRILE  CUTANEOUS  DISEASES. 
EXANTHEMATA. 

These  fevers,  like  some  of  those  heretofore  describ 
ed,  can  only  arise  from  certain  specific  morbific  con 
tagions  which  give  rise  to  uniform  and  readily  re 
cognised  symptoms.  They  all  commence  with  gene 
ral  febrile  disturbance,  followed  sooner  or  later  by 
eruptions,  and  other  characteristic  symptoms,  which 
serve  to  distinguish  each  particular  variety. 

A  peculiarity  attending  this  class  of  diseases,  is, 
that  a  single  attack  usually  renders  the  subject  safe 
against  any  future  action  of  the  morbific  poison.  I 
have,  however,  witnessed  two  or  three  well  marked 
examples  of  second  attacks  of  scarlatina  in  the  same 
individuals. 

The  maladies  which  we  shall  notice  under  this 
head,  are,  Scarlatina,  Rubeola,  Variola,  Varicella,  Mi- 
liar  y  fever  9  Roseola,  Urticaria,  Erysipelas,  Plague. 

SECTION  I. 

SCARLATINA. SCARLET  FEVER. 

This  fever  has  been  divided  into  three  varieties, 
namely:  first,  Scarlatina  simplex;  second,  /Scarlatina 
anginosa  ;  third,  Scarlatina  maligna. 

In  its  simple  form,  scarlet  fever  is  not  attended 
with  danger,  but  runs  its  course  mildly  like  a  simple 
continued  fever,  and  terminates  in  five  or  six  days  in 
convalescence. 

In  the  other  varieties,  however,  inflammations  and 
congestions  often  supervene  soon  after  the  attack, 
and  if  not  promptly  met  by  suitable  remedies,  gan 
grene,  sloughing,  and  fatal  disorganizations  occur  in 
the  throat,  larynx,  and  other  important  parts  of  the 
organism. 

Scarlet  fever  is  of  much  more  frequent  occurrence 


FEBRILE  CUTANEOUS  DISEASES.  199 

in  the  fall  and  winter,  than  during  the  summer 
months.  Its  attacks  are  usually  confined  to  children 
passed  the  nursing  period,  and  persons  under  twenty 
years  of  age ;  but  it  may  occur  at  all  ages  from  in 
fancy  to  old  age. 

1.       SCARLATINA    SIMPLEX. 

Diagnosis. — Shiverings,  succeeded  by  heat,  mode 
rate  thirst,  frequent  pulse,  slight  soreness  of  the 
throat,  nausea,  loss  of  appetite,  headache :  —  After 
these  symptoms  have  continued  about  forty-eight 
hours,  a  scarlet  eruption  makes  its  appearance  upon 
the  face,  extending  gradually  downwards  to  the  neck, 
trunk,  and  extremities.  This  eruption  consists  of  an 
immense  number  of  fine  pimples  (aptly  compared  by 
Dr.  Armstrong  to  a  boiled  lobster  shell),  either  run 
ning  together  and  diffusing  themselves  uniformly  over 
the  skin,  or  appearing  in  patches  in  different  parts  of 
the  body.  Upon  the  appearance  of  this  eruption, 
many  of  the  unpleasant  symptoms,  like  nausea,  op 
pression  at  the  stomach,  dyspnoea,  &c.,  abate,  and  the 
case  thus  progresses  until  the  fourth  or  fift'h  day  of 
the  fever,  when  desquamation  of  the  cuticle  takes 
place,  and  a  happy  convalescence  usually  ensues. 

2.       SCARLATINA    ANGINOSA. 

Diagnosis.  —  The  anginose  variety  of  scarlet  fever 
is  ushered  in  with  chilliness  and  shiverings,  succeeded 
by  intense  heat  and  pungency  of  the  skin,  frequent 
and  hard  pulse,  nausea,  vomiting,  headache,  sore 
throat,  painful  deglutition,  intense  thirst,  pain  and  ten 
derness  of  the  epigastrium,  abdomen  tender,  pain  and 
stiffness  in  the  neck,  tongue  covered  with  a  whitish 
or  yellowish  fur,  through  which  the  papillae  are  seen 
red,  inflamed,  and  prominent ;  fauces,  throat,  and  ton 
sils  swollen,  deep  red,  inflamed,  or  ulcerated ;  eyes 
red  and  injected,  voice  thick  and  hoarse,  sometimes 
dyspnoea  and  cough,  and  universal  tenderness  of  the 
whole  surface. 

These  symptoms  continue  an  indefinite  period,  vary 
ing  from  two  to  five  days,  when  the  eruption  shows 
itself,  either  uniformly  diffused  over  the  body,  or  in 


200  FEBRILE    CUTANEOUS    DISEASES. 

irregular  blotches.  If  the  disease  progresses  favour 
ably,  the  skin  desquamates  in  from  six  to  eight  days 
from  the  commencement  of  the  fever,  the  febrile  symp 
toms  all  subside,  the  ulcers  in  the  throat  granulate 
kindly,  and  a  speedy  convalescence  obtains.  On 
the  contrary,  if  the  eruption  prematurely  disappears 
from  the  surface,  the  ulcers  assume  a  foul  and  unhealthy 
appearance,  secreting  an  acrid  and  highly  irritat 
ing  fluid ;  while  the  fever  continues  to  rage  with  un 
abated  severity.  We  may  have  a  supervention  of  ab 
dominal,  bronchial,  or  cerebral  inflammation,  which 
will  complicate  the  malady  in  a  serious  and  perhaps  fa 
tal  manner. 

"  In  this  fever,  the  temperature,  as  indicated  by  the 
thermometer,  rises  several  degrees  higher  than  in  any 
other."*  The  pulse  is  also  more  rapid  and  strong  than 
in  almost  any  other  fever,  indicating  conclusively  that 
it  is  an  affection  of  an  inflammatory  character. 

3. SCARLATINA    MALIGNA. 

Diagnosis. — Scarlatina  maligna  was  formerly  known 
under  the  name  of  "  putrid  sore  throat,"  and  is  at  pre 
sent  designated  by  some  writers  as  scarlatina  typhoides. 
It  is  unquestionably  one  of  the  most  dangerous  mala 
dies  with  which  the  physician  has  to  contend.  It  ge 
nerally  commences  with  the  common  precursory 
symptoms  of  the  anginose  form,  which,  however,  very 
soon  give  way  for  a  train  of  symptoms  bearing  a  close 
resemblance  to  typhus.  The  eruption  is  either  entirely 
wanting,  or  makes  its  appearance  only  partially,  in 
irregular  blotches  of  a  pale  colour  ;  the  heat  of  the 
skin  often  subsides  below  the  natural  standard  ;  the 
pulse  becomes  very  frequent  and  weak  ;  the  counte 
nance  assumes  a  besotted  expression  ;  the  eyes  become 
dull  and  suffused  ;  the  throat  is  filled  with  ash-colour 
ed  ulcers ;  fauces,  larynx,  and  bronchia  inflamed  and 
swollen  ;  an  acrid  discharge  issues  from  the  nostrils  ; 
the  tongue,  at  first  red,  soon  becomes  dry  and  black  ; 
the  surface,  in  the  advanced  stages,  acquires  a  dark 
red  or  mahogany  colour,  and  petechise,  diarrhoea,  and 
haemorrhages  finally  ensue.  The  ulcers  in  the  throat 

*  Southwood  Smith,  on  Fever. 


FEBRILE    CUTANEOUS    DISEASES.  201 

often  slough  and  extend  in  all  directions,  involving  in 
their  ravages  the  cartilages  of  the  larynx  and  the  soft 
parts  within  the  nostrils. 

If  the  disease  seizes  particularly  upon  the  brain, 
lungs,  or  abdominal  viscera,  there  will  be  a  predomi 
nance  of  those  symptoms  which  characterize  the  disor 
ders  of  these  particular  parts.  From  the  tendency  of 
this  malady  to  these  different  organs,  some  authors 
have  subdivided  scarlatina  maligna  into  the  inflamma 
tory,  congestive,  and  mixed  varieties.  Examples  have 
occasionally  occurred  in  my  own  practice,  in  which, 
in  the  very  onset  of  the  malady,  those  symptoms  have 
appeared,  indicating  congestion  of  the  brain, — as 
coma  ;  slow,  oppressed,  and  noisy  respiration;  sighing; 
face  pale  or  livid,  skin  cold,  pulse  slow  and  irregular, 
pupils  contracted  or  dilated.  In  these  cases,  the  erup 
tion  seldom  comes  out  well,  but  is  of  a  pale  colour, 
and  shows  itself  irregularly  in  different  parts  of  the 
body. 

In  other  instances  the  inflammation  seizes  upon  the 
laryngeal,  bronchial,  or  intestinal  mucous  membranes, 
thus  often  deciding  the  case  against  the  patient,  when 
the  local  affection  of  the  throat  seemed  to  be  progress 
ing  favourably. 

Causes. — Scarlatina  can  only  proceed  from  a  speci 
fic  morbific  contagion,  respecting  the  nature  of  which 
we  are  entirely  ignorant.  Whether  this  contagion  is 
generated  and  diffused  solely  by  those  suffering  under 
the  disease,  or  whether,  as  some  pathologists  assert,  it 
may  be  generated  in  the  atmosphere  independently  of 
the  animal  body,  is  a  question  which  admits  of  discus 
sion,  although  we  entertain  the  former  opinion.  Of 
this  we  are  confident,  that  when  the  agent  is  infinites- 
imally  diffused  in  the  air,  it  is  capable  of  being  ab 
sorbed  into  the  circulation,  and  of  producing  its  speci 
fic  morbific  effects  upon  the  organism. 

Some  have  doubted  the  contagiousness  of  this  affec 
tion,  because  certain  individuals  of  families  occasionally 
escape,  while  others  are  affected  ;  but  let  it  be  remem 
bered,  that  this  happens  now  and  then  in  smallpox, 
plague,  typhus,  and  all  other  maladies  which  are  uni 
versally  deemed  contagious. 

We  have  before  observed,  that  the  contagion  of  ty- 
9* 


202  FEBRILE    CUTANEOUS    DISEASES. 

phus  cannot  make  a  serious  impression  upon  the  or 
ganism,  so  long  as  every  part  is  in  a  perfect  state  of 
health  and  vigour.  The  same  remark  will  apply  with 
equal  truth  to  the  disease  under  consideration.  In 
these  cases,  the  tissues  on  which  the  poison  operates, 
are  stronger  than  the  noxious  influence,  and  are  thus 
enabled  to  resist  its  action  until  some  cause  predisposes 
the  system  to  receive  the  impression. 

Therapeutics. — The  provings  of  belladonna  upon  the 
healthy  subject,  as  well  as  the  numerous  successful 
experiments  made  at  the  bedside  of  the  sick,  have 
stamped  it  as  a  remedy  of  distinguished  importance  in 
the  treatment  of  scarlet  fever.  It  has  even  been  extol 
led  by  eminent  practitioners  of  the  old  school,  and  in 
some  instances  adopted,  both  as  a  remedy  in  this  dis 
ease,  and  as  a  valuable  prophylactic  against  it. 

In  the  scarlatina  simplex,  an  occasional  dose  of  this 
medicine  at  the  third  attenuation,  will  suffice  to  conduct 
the  patient  safely  through  the  malady.  Should  the  fe 
brile  symptoms  run  high,  the  belladonna  may  be  ad 
vantageously  preceded  by  aconite. 

In  the  anginose  form,  where  there  is  intense  inflam 
matory  excitement,  swelling  and  soreness  of  the 
throat,  painful  deglutition,  quick  pulse,  burning  hot 
skin,  nausea,  tenderness  at  the  epigastrium,  belladonna 
is  still  the  grand  remedy.  If  the  fever  assumes  a  vio 
lent  character,  evincing  a  tendency  to  excite  inflam 
matory  action  in  any  particular  structure,  aconite  may 
here  also  be  administered  with  advantage,  either  by 
itself,  or  in  alternation  with  belladonna.  So  long  as 
the  local  inflammation  in  the  throat  is  retained  within 
due  bounds,  and  the  eruption  shows  itself  in  a  proper 
manner,  remaining  out  a  sufficient  length  of  time,  we 
shall  receive  ample  aid  from  these  potent  remedies. 
We  take  the  liberty  of  introducing  the  following  spe 
cial  symptoms  of  belladonna,  from  Drs.  Curre,  Her 
mann,  Laurie,  &c.  : 

External  indications. — Spots  of  a  scarlet  or  deep 
red  colour  on  the  face,  or  other  parts  of  the  body ; 
swelling  of  the  submaxillary  glands,  and  those  of  the 
neck ;  eyes  red,  sparkling,  and  convulsed,  or  fixed, 
shining,  and  prominent ;  pupils  dilated  or  contracted  ; 
tongue  red,  hot,  and  dry,  or  white  in  the  centre,  with 


FEBRILE    CUTANEOUS    DISEASES.  803 

red  edges;  throat,  tonsils,  uvula,  and  velum-palati 
dry,  inflamed  and  swollen  ;  suppuration  of  the  tonsils  ; 
strong  pulsations  of  the  temporal  arteries  ;  inflamma 
tion  of  the  stomach  and  abdomen ;  constipation,  or 
involuntary  evacuations  ;  urine  turbid,  of  a  brownish 
red  or  yellow  colour,  with  a  red  or  whitish  sediment ; 
pulse  small  and  quick,  or  strong  and  quick,  or  full  and 
slow,  or  small  and  slow,  or  hard  and  tense  ;  pulsations 
of  the  carotids ;  face  hot,  red,  and  bloated ;  sweat 
with  the  heat,  or  after  it. 

Physical  sensations. — Vertigo,  confusion,  fulness, 
heaviness,  pressure ;  shooting  or  expansive  pain  in  the 
head,  aggravated  by  motion  of  the  head  or  eyes,  by 
contact,  and  by  cold  air,  mitigated  by  holding  the 
head  back,  and  by  supporting  it ;  mouth  dry  and  hot ; 
dryness  and  burning  in  the  throat,  with  painful  and 
difficult  deglutition ;  loss  of  appetite ;  nausea  and 
vomiting  ;  great  thirst ;  sense  of  fulness  and  distention 
in  the  stomach  and  abdomen  after  eating ;  drawing 
pains  in  the  back  and  shoulders ;  difficult  respiration ; 
violent  cough ;  shiverings,  alternating  with  heat,  or 
followed  by  heat,  worse  in  the  evening  or  night; 
adypsia,  or  excessive  thirst ;  dry,  burning  heat. 

Mental  and  moral  symptoms. — Great  agitation  and 
tossing  about ;  anguish  and  inquietude  in  the  after 
noon  and  night ;  delirium,  with  muttering,  groans,  and 
cries  ;  vivid  and  frightful  dreams ;  starting  from  sleep 
with  fright,  groans,  and  cries ;  ill  humour  and  irrita 
bility. 

The  same  writers  give  us  the  following  special  in 
dications  for  the  employment  of  aconite: 

External  indications. — Face  red,  hot,  and  bloated, 
or  alternately  red  and  pale ;  skin  dry  and  hot ;  fore 
head  cold,  and  tips  of  the  ears  hot  ;  deep  redness  of 
the  throat ;  bilious  or  mucous  vomitings  ;  urine  scanty, 
deep  red,  with  brick-coloured  sediment ;  pulse  hard, 
frequent,  and  accelerated ;  respiration  rapid  and 
difficult. 

Physical  sensations. — Oppressive  or  throbbing  pains 
in  the  head,  aggravated  by  motion ;  talking,  rising  up, 
&c,  ;  better  in  the  open  air ;  great  sensibility  of  the 
affected  parts  to  the  touch,  or  on  movement ;  pains  in 
the  joints  and  limbs ;  fainting  and  weakness ;  ex- 


204  FEBRILE    CUTANEOUS    DISEASES. 

treme  thirst ;  coldness  of  the  surface,  with  internal 
heat,  or  burning  over  the  whole  body  ;  pain  in  the 
throat,  and  difficult  deglutition  ;  burning  and  prickling 
in  the  throat  in  swallowing ;  bitter  or  putrid  taste  ; 
loss  of  appetite  ;  sense  of  swelling,  weight,  or  pres 
sure  in  the  prsecordial  region  ;  hot  and  burning  urine  ; 
bruised  pains  in  the  loins,  back,  and  nape  of  the  neck. 

Mental  and  moral  symptoms. — Discouragement  and 
agitation ;  noise  appears  insupportable  ;  humour 
changeable :  at  one  time  sad,  depressed,  irritable,  con 
tradictory,  despairing,  at  other  times  excited,  gay,  and 
full  of  hope  ;  inquietude  under  disease,  and  even  des 
pair  respecting  a  cure. 

If  there  is  slight  fever  through  the  day,  but  an  in 
crease  in  the  evening,  with  sleeplessness,  sadness,  des 
pondency,  and  tears,  ipecacuanha  is  our  remedy.  The 
following  are  the  particular  symptoms  which  point  to 
this  medicine : 

External  indications. — Face  pale,  sallow,  yellowish, 
and  bloated,  with  livid  circles  round  the  eyes  ;  tongue 
loaded  with  a  white  or  yellowish  fur  ;  profuse  secre 
tion  of  saliva  ;  vomiting  of  green,  bilious,  acid,  slimy, 
or  gelatinous  matter ;  sweat ;  fetid  breath  ;  turbid 
urine,  with  sediment  like  brickdust. 

Physical  sensations. — Nausea  and  vomiting  of  drinks 
or  food ;  no  appetite ;  insipid  and  clammy  taste ; 
adypsia ;  violent  itching  of  the  skin  ;  empty  risings  ; 
great  uneasiness  in  the  stomach  and  epigastrium  ; 
feeling  of  emptiness  and  flaccidity  in  the  stomach  ; 
sensation  of  debility  in  the  bowels,  worse  on  motion ; 
colic,  with  agitation  ;  tossing,  with  cries ;  diarrhoea, 
with  nausea;  griping  and  vomiting. 

Mental  and  moral  symptoms. — Anxiety  and  fear  of 
death  ;  moroseness  ;  cries,  and  howling  ;  vague  desire 
for  different  things. 

When  the  disease  commences  with  prominent  de 
rangement  of  the  stomach  and  bowels,  headache,  ver 
tigo,  shiverings,  weakness,  nausea,  and  nose-bleed, 
soon  succeeded  by  hasty,  anxious,  and  oppressed  res 
piration,  mucous  vomiting,  taste  of  food,  longing  for 
acids,  spirits,  or  beer  ;  flatulence  ;  adypsia,  or  great 
thirst ;  constant  anxiety,  moaning,  or  sighing,  and  dis 
turbed  sleep,  pulsatilla  is  appropriate. 


FEBRILE    CUTANEOUS    DISEASES.  205 

Scarlatina  occurring  in  individuals  of  decidedly 
scrofulous  dyscrasias,  will  sometimes  require  the  em 
ployment  of  sulphur,  or  calcarea  carb. 

Dr.  Elb,  of  Dresden,  advises  zinc  in  those  cases 
where  paralysis  of  the  brain  is  threatened,  or  when  it 
already  exists.  He  has  likewise  used  it  with  success 
in  the  malignant  form,  with  violent  delirium,  alterna 
ting  with  sopor  ;  icy  coldness  of  the  skin  from  sunken 
vitality  ;  small  and  frequent  pulse,  and  fixed  and  stu 
pid  expression  of  the  eyes.  Dr.  E.  usually  employs 
the  first  trituration  in  grain  doses  every  two  to  six 
hours. 

Occasionally,  troublesome  ulcers  form  in  the  mouth, 
throat,  and  upon  the  tonsils,  covered  with  ash-coloured 
sloughs  ;  deglutition  becomes  exceedingly  difficult, 
and  is  attended  with  a  stinging  pain ;  the  fluids  which 
the  patient  attempts  to  swallow,  often  escaping 
through  his  mouth  and  nose,  with  perhaps  an  acrid 
discharge  from  the  nostrils,  and  profuse  secretion  of 
saliva.  Under  these  circumstances,  mercurius  is  a 
proper  remedy. 

In  malignant  scarlet  fever,  where,  in  addition  to  the 
above  symptoms,  we  have  inflamed,  swollen,  and  ten 
der  salivary  glands,  dark-coloured  ulcers,  with  a  de 
cided  tendency  to  slough  and  extend,  together  with 
great  debility,  lassitude,  tremours,  obtuseness  of  intel 
lect,  cold  extremities,  and  other  signs  of  a  typhoid 
condition,  muriatic,  or  nitric  acid,  from  the  first  to  the 
third  dilution,  should  be  exhibited. 

If,  at  the  same  time,  there  should  be  present  a  con 
siderable  amount  of  pulmonary  or  cerebral  excitement, 
indicated  by  delirium,  restlessness,  contracted  or  di 
lated  pupils,  heaviness  and  dull  pain  in  the  head  on 
motion,  difficult,  anxious,  and  sighing  respiration,  sen 
sation  of  weight  and  pressure  upon  the  chest,  trou 
blesome,  hacking  cough,  with  soreness  and  sensitive 
ness  of  the  whole  surface,  bryonia,  third  dilution,  may 
be  called  into  requisition. 

Arsenicum  is  a  remedy  of  great  power  in  the  ad 
vanced  stages  of  malignant  scarlatina,  where  there 
are  extreme  prostration,  pain  in  the  stomach  and  abdo 
men,  diarrhoea,  eruption  of  a  livid  or  mahogany 
colour,  ulcers  dark  and  foul,  tongue  and  lips  dry  and 


206  FEBRILE    CUTANEOUS    DISEASES. 

black,  pulse  extremely  frequent  and  weak,  cold,  clam 
my  sweats,  hippocratic  countenance.  This  remedy 
has  often  rescued  patients  from  the  grave  who  have 
been  given  over  in  despair  by  physicians  of  the  old 
school. 

Should  profound  coma  supervene  during  the  course 
of  the  malady,  with  snoring  and  open  mouth,  open 
and  convulsed  eyes,  red  and  puffed  face,  hanging  jaw, 
difficult,  slow,  or  intermittent  respiration,  convulsive 
movements  of  different  muscles,  retention  of  urine, 
&c.,  opium  will  be  found  the  best  specific.  We  are 
satisfied  that  this  is  an  agent  which  will  rarely  dis 
appoint  our  expectations  in  instances  of  this  descrip 
tion. 

When  the  rash  suddenly  disappears  during  the 
eruptive  stage,  Drs.  Schmidt,  Hartmann,  and  others, 
recommend  very  highly  acetat,  cuprum  as  a  specific 
against  this  symptom.  Sulphur,  iodine,  bryonia,  phos 
phorus,  and  belladonna  also  deserve  consideration,  and 
will,  in  some  cases,  promptly  restore  eruptions  which 
have  been  prematurely  repelled. 

The  other  remedies  which  may  be  consulted  in 
cases  where  those  above  described  do  not  accord  with 
the  symptoms,  are,  ipecac.,  nux  v.f  carb.  veg.,  rhus  tox., 
stram.,phos.,  Itreosote,  hyos. 

For  the  troublesome  sequela  which  sometimes  fol 
low  scarlet  fever,  as  dropsical  affections,  purulent 
otorrh&a,  deafness,  furunculi,  enlargements  and  suppu 
ration  of  the  glands  of  the  neck,  axilla,  and  groin, 
appropriate  remedies  may  be  found  in  apis.,  mel.,  ars., 
dig.,  hellebore,  sulph.,  hep.,  senega,  cham.,  aur.  mur., 
and  mere. 

Administration. — We  most  commonly  employ  the 
first,  second,  and  third  attenuations  ;  but  in  young 
and  impressible  children,  we  often  resort  to  the  higher 
dilutions  with  the  most  satisfactory  results.  Some 
cases  are  characterized  from  the  commencement  by  a 
high  state  of  vascular  and  nervous  excitement,  while 
others  evince  a  loss  of  vascular  and  nervous  power, 
and  a  very  low  grade  of  impressibility.  The  propriety, 
therefore,  of  the  employment  of  both  the  high  and 
low  attenuations,  in  different  instances,  is  evident.  If 
dilutions  are  used,  a  drop  may  be  given  at  a  dose,  in 


FEBRILE    CUTANEOUS    DISEASES.  207 

a  drachm  of  water  ;  but  if  the  triturations  are  select 
ed,  one  grain  is  a  suitable  dose,  given  dry  or  in  water. 
We  advise  a  frequent  repetition  of  the  dose  until 
decided  changes  arise  from  the  remedy,  or  until  we 
are  satisfied  that  it  is  not  producing  the  required 
effect  upon  the  disordered  structures. 

SECTION  II. 

RUBEOLA. MEASLES. 

Formerly,  measles  and  scarlet  fever  were  described 
and  treated  as  one  and  the  same  disease,  the  differ 
ences  which  were  observed  in  different  cases  being 
ascribed  to  modifications  originating  from  peculiari 
ties  of  constitution,  the  state  of  the  atmosphere,  and 
other  accidental  causes.  About  fifty  years  ago,  how 
ever,  Withering,  and  several  other  writers,  recognised 
a  distinction  between  them  ;  and  measles,  for  the  first 
time,  was  accurately  described  and  ranked  as  a  dis 
tinct  malady. 

As  it  generally  occurs,  it  is  unattended  with  danger, 
unless  interfered  with  by  purgatives,  emetics,  and  in 
fusions.  Fortunately,  it  is  confined  for  the  most  part 
to  children,  for  when  adults  are  the  subjects  of  at 
tack,  it  is  far  more  severe  and  dangerous.  Like  scar 
latina,  one  attack  renders  the  subject  secure  against 
any  future  operation  of  the  contagion. 

Diagnosis. — Tlfe  precursory  symptoms  of  measles 
are  similar  to  those  of  ordinary  catarrhal  fever :  as 
lassitude,  chilliness,  sneezing,  coryza,  red  and  watery 
eyes,  headache,  nausea,  slight  soreness  of  the  throat, 
short,  hoarse  cough,  pain  and  soreness  in  the  chest ; 
dyspnosa,  heat,  and  thirst.  These  symptoms  continue 
with  more  or  less  severity  for  four  or  five  days,  when 
the  eruption  makes  its  appearance,  commencing  at 
the  forehead,  and  proceeding  gradually  downwards  to 
the  neck,  breast,  arms,  body,  and  lower  extremities. 
About  the  period  of  the  eruptive  stage,  there  is  usual 
ly  an  increase  of  the  febrile  symptoms,  which  continue 
for  four  or  five  days,  when  a  bran-like  scurf  is  cast 
off  from  the  surface,  and  the  fever  subsides.  During 
the  fever,  the  cough  is  often  very  trublesome,  and 
sometimes  terminates  in  inflammation  of  the  bronchia 


208  FEBRILE    CUTANEOUS    DISEASES. 

or  lungs.  Schroen  thus  describes  the  malady  :  "Small, 
scattered,  red  spots,  in  the  centre  of  which  we  ge 
nerally  find  a  small  pimple.  These  spots  soon  be 
come  confluent,  and  spread  over  the  whole  body,  after 
being  preceded  by  catarrhal  fever,  for  three  or  four 
days,  attended  with  redness  of  the  mucous  membrane 
of  the  mouth,  with  cough,  catarrh,  dread  of  light,  and 
flow  of  tears.  They  disappear  upon  pressure,  and 
develope  themselves  again  from  the  centre  towards 
the  periphery,  after  the  pressure  is  removed.  The 
pimple  becomes  a  small  yellow  prominence  in  the 
course  of  sixteen  hours,  when  a  scurfy  desquamation 
commences." 

The  attentive  observer  will  have  no  difficulty  in 
distinguishing  this  malady  from  scarlatina,  by  the 
following  marks  of  difference  :  the  primary  symptoms 
of  measles  are  red  and  watery  eyes,  sneezing,  fluent 
coryza,  short  cough  and  some  hoarseness.  These 
signs,  which  are  almost  uniformly  present  in  this  dis 
ease,  are  usually  wanting  in  scarlet  fever.  In  the 
general  character  and  appearance  of  the  eruption  also 
there  is  a  marked  difference.  The  scarlatina  rash  is 
composed  of  innumerable  fine  pimples,  resembling  in 
appearance  the  shell  of  a  boiled  lobster,  uniformly 
diffused  over  the  surface,  and  of  a  bright  scarlet  colour. 
The  eruption  of  measles  appears  in  spots  (sometimes 
papular)  resembling  flea-bites,  which  run  together  and 
form  semi-lunar  patches.  There  iS  a  roughness  or 
elevation  where  the  eruption  exists,  perceptible  to  the 
touch  :  and  which  is  not  usually  observed  in  scar 
latina.  But  one  of  the  best  marks  of  distinction  is  the 
difference  in  the  colour  of  the  rash,  that  of  measles 
being  a  purplish,  or  darkish  scarlet,  while  that  of 
scarlet  fever  is  a  light  scarlet. 

Measles  is  a  disease  which,  under  different  circum 
stances,  assumes  a  great  variety  of  forms,  both  as  to 
its  general  character  and  violence.  During  some 
seasons  it  prevails  as  a  mild  and  simple  affection,  re 
quiring  little  or  no  treatment ;  while  at  other  periods 
it  assumes  a  highly  inflammatory,  congestive,  or 
typhous  character.  Sometimes  almost  all  cases  seem 
to  have  a  tendency  to  run  on  to  pneumonia ;  at  other 
times  cerebral  or  typhoid  symptoms  predominate  ;  in 


FEBRILE    CUTANEOUS    DISEASES.  209 

still  other  instances,  gastric  disorder  prevails  ;  but  in 
the  great  mass  of  cases,  the  malady  is  mild  and  trac 
table. 

In  contemplating  the  numerous  varieties  of  this,  as 
well  as  of  most  other  diseases,  the  impartial  physician 
must  acknowledge  the  utter  uncertainty  and  empyri- 
cism  of  prescriptions  guided  only  by  the  name  of  a 
disease. 

Causes. — In  common  with  the  other  contagious  dis 
orders,  measles  arises  from  a  specific  morbific  conta 
gion.  This  has  been  amply  proved  by  Home,  Dewees, 
Speranza,  and  Majendie,  who,  in  numerous  instances, 
succeeded  in  communicating  this  affection  by  inocu 
lation.  The  season  of  the  year,  the  condition  of  the 
atmosphere,  and  the  peculiar  circumstances  of  the 
individuals  exposed,  exercise  a  powerful  and  perhaps 
controlling  influence,  in  determining  the  character  of 
the  epidemic.  When  measles  prevail  during  seasons 
of  influenza,  typhus,  or  dysentery,  the  disease  will  par 
take  of  the  peculiar  character  of  the  existing  epidemic, 
and  its  course  be  modified  accordingly. 

Therapeutics. — The  most  common  medicines  in  the 
treatment  of  measles,  are,  aeon.,  andpuls. :  next  in  im 
portance  stand  bry.,  bell.,  ipecac.,  mere.,  sulph.,  cup.  ac.9 
rhus,  ac.,  phos.,  ars.,  cham.,  fyc. 

Schroen  recognises  five  different  varieties  of  measles, 
founded  upon  the  characteristic  symptoms  present  in 
each  given  case :  viz.,  first,  the  simple  or  ercthistic,  in 
which  aconite  is  the  appropriate  remedy ;  second,  the 
inflammatory,  requiring  the  use  of  aconite,  bryonia,  and 
belladonna  ;  third,  the  gastric,  demanding  the  employ 
ment  of  pulsatilla,  cliamomela,  ipecacuanha,  and  vera- 
trum  ;  fourth,  the  typhus,  or  irregular,  calling  for  rhus 
tox.,  china,  nux  vom.,  and  belladonna  ;  fifth,  the  septic,  or 
malignant,  corresponding  with  acid,  phos.,  acid,  sulph., 
acid,  mur.,  opii,  and  arsenicum. 

At  the  commencement  of  an  attack,  when  heat, 
thirst,  quick  pulse,  red,  inflamed,  and  watery  eyes, 
sneezing,  fluent  coryza,  cough,  dyspnoea,  oppression  at 
the  chest,  and  sore  throat  are  present,  aconite  at  the 
third  potency  is  the  most  suitable  remedy.  So  long 
as  the  disease  progresses  mildly,  running  through  its 
regular  stages  in  due  form,  no  other  medicine  will  be 


210  FEBRILE    CUTANEOUS    DISEASE?!. 

requisite  to  complete  the  cure.  Even  in  those  com 
plications  which  call  for  the  use  of  other  medicines, 
as  pneumonia,  croup,  cerebral  or  gastric  disturbance, 
whether  occurring  before,  during,  or  subsequent  to  the 
eruption,  should  the  inflammatory  excitement  run 
high,  aconite  will  still  be  required.  Its  repetition 
must,  of  course,  be  subject  to  the  circumstances  of 
each  particular  case. 

When  there  exists  a  predominance  of  catarrhal 
symptoms,  and  a  tardiness  in  the  appearance  of  the 
eruption,  we  have  an  appropriate  remedy  in  pulsatilla. 
This  medicine  may  often  succeed  aconite  with  peculiar 
advantage  in  the  catarrhal  forms  of  more  than  ordinary 
severity.  In  these  cases,  some  writers  claim  for  this 
agent  important  prophylactic  properties.  It  is  also  a 
valuable  in  retrocession  of  measles,  attended  with  one 
or  more  of  the  following  symptoms  :  hoarseness,  swell 
ing  of  the  parotids,  puffiness  of  the  face,  pain  in  the 
ears,  discharges  from  the  ears,  hardness  of  hearing, 
dry  short  cough,  great  restlessness,  pains  in  the  head, 
back,  and  loins,  and  mu(5ous  diarrhosa. 

Dr.  Croserio  believes  pulsatilla  to  be  especially 
adapted  to  measles,  not  only  as  a  remedy,  but  as  a 
prophylactic.  He  asserts  that  "  it  is  to  this  disease, 
almost  what  belladonna  is  to  scarlet  fever.  The  pre 
cursory  symptoms  of  measles  accord  perfectly  with 
the  febrile  symptoms  of  pulsatilla,  viz.,  chills,  heat, 
lassitude,  throbbing  pains  in  the  head,  anxiety,  nausea, 
vomiting  of  bile  or  glairy  mucus,  violent  coryza,  red 
eyes,  lachrymation,  photophobia,  &c.  Then  follow 
pricking  of  the  skin,  red  spots  like  flea-bites,  excoria 
tion  and  creeping  in  the  throat,  difficult  deglutition, 
dry,  fatiguing  cough,  epistaxis,  &c.  If  given  in  the 
precursoiy  stage,  I  have  often  seen  the  disease  termi 
nate  in  abundant  perspiration  in  twenty- four  hours." 

Belladonna  is  indicated  when  the  throat  is  much 
inflamed  and  swollen,  with  very  painful  and  difficult 
deglutition,  short,  hacking,  throat  cough,  inflamed 
eyes,  nervous,  uneasy  and  sometimes  delirious,  hurried 
respiration,  headache,  intense  thirst,  dry  hot  skin,  and 
signs  of  cerebral  disturbance.  It  has  likewise  been 
recommended  in  cases  of  sudden  disappearance  of  the 
eruption  after  having  been  out  one  or  two  days. 


FEBRILE    CUTANEOUS    DISEASES.  211 

"  When  the  eruption  suddenly  disappears  and  is 
succeeded  by  fever,  violent  headache  and  breathless- 
ness,  great  benefit  will  be  derived  from  the  adminis 
tration  of  aconite  and  arsenicum  alternately ;  and 
afterwards,  when  the  head  appears  to  be  the  chief 
point  of  attack,  indicated  by  excruciating  headache, 
screaming  or  moaning  during  the  night,  belladonna  and 
cuprum  aceticum,  repeated  every  hour  or  two,  will 
afford  marked  relief." — (British  Jour,  of  Horn.,  No. 
xxiv.,  p.  232.) 

Bryonia  will  apply  in  cases  attended  with  marked 
pectoral  symptoms,  like  stitches  or  darting  pains  in  the 
side  and  chest,  anxious,  sighing,  difficult  and  painful 
respiration,  and  very  great  general  uneasiness. 

Hartmann  says,  that  bryonia  "  is  also  a  powerful  rem 
edy  in  retrocessent  measles,  in  reproducing  the  eruption 
on  the  surface,  or  in  rendering  its  disappearance 
harmless.  In  these  cases  I  give  bryonia  in  the  fifteenth 
dilution,  and  notice  that  it  is  chiefly  indicated,  if  after 
the  retrocession  of  the  eruption,  a  morbid  affection  of 
the  eyes  supervenes,  which  resembles  that  which  I 
lately  noticed  when  speaking  of  ophthalmia." 

Ipecacuanha  should  be  administered  when  there  is 
gastric  disorder,  indicated  by  nausea,  vomiting,  pain 
and  oppression  in  the  stomach,  and  inability  to  retain 
food  or  drinks. 

For  the  ulcers  which  sometimes  form  in  the  mouth 
and  throat,  also  the  glandular  swellings  which  occur 
in  the  neck,  mercurius  is  a  valuable  specific. 

As  a  remedy  for  the  restoration  of  retrocessent  mea 
sles,  as  well  as  for  the  inflammatory  affections  of  the 
eyes,  which  now  and  then  remain  as  sequela  of  this 
malady,  sulphur  is  sometimes  a  remedy  of  the  highest 
importance.  Many  cases,  after  having  apparently 
ran  their  courses  in  a  mild  and  regular  manner,  leave 
the  patient  with  some  annoying  dreg,  like  discharges 
from  the  ears,  weak  eyes,  eruptions  of  various  kinds, 
or  chronic  cough,  with  profuse  expectoration,  which 
are  attributable  to  somemiasm  which  has  been  roused 
during  the  course  of  the  disease.  For  the  cure  of  cases 
of  this  description,  sulphur  is  an  indispensable  agent. 

We  occasionally  meet  with  nervous  or  typhoid 
symptoms  which  render  the  use  of  ars.,  rhus  tox.,  strain.. 


212  FEBRILE    CUTANEOUS    DISEASES. 

op.,  and  phos.  necessary.  Whatever  symptoms  present 
themselves,  the  judicious  physician  will  be  able  to  se 
lect  from  the  great  number  of  medicines  of  which  the 
pure  effects  are  known,  those  that  are  precisely 
homoBopathic  to  the  malady. 

Administration. — In  cases  of  children,  we  employ 
from  the  third  to  the  sixth  attenuations  ;  and  in  those 
of  adults,  from  the  first  to  the  third.  Our  repetitions 
must  be  governed  by  the  nature  of  the  case,  and  the 
effects  produced  by  the  medicine. 

SECTION  III. 

VARIOLA. SMALLPOX. 

Two  varieties  of  this  disease  have  generally  been 
recognised  by  pathologists ;  one  termed  distinct  and 
the  other  confluent.  The  former  is  more  mild  and  less 
dangerous  than  the  latter,  being  attended  with  less  se 
vere  constitutional  disturbance,  and  having  detached, 
distinct,  and  fewer  pustules,  which  are  surrounded  by  a 
pale  red  areola.  The  confluent  variety,  by  the  pus 
tules  running  together  and  meeting  each  other,  pre 
sents  the  appearance  of  a  uniform  and  homogeneous 
swelling,  from  which  it  has  derived  its  name. 

Diagnosis. — Smallpox  may,  with  propriety,  be  di 
vided  into  the  following  stages  or  periods,  viz.  :  1,  the 
primary  fever ;  2,  the  eruptive  stage ;  3,  the  maturing 
period  ;  4,  the  period  of  exsiccation. 

The  primary  fever  in  the  distinct  variety  is  ushered 
in  with  lassitude,  rigours,  pains  in  the  head,  back,  and 
loins,  slight  sore  throat,  soon  followed  by  nausea  and 
vomiting, pain  at  the  epigastrium,  often  severe,  with  ten 
derness  on  pressure,  hot  and  dry  skin,  thirst,  scanty  and 
high-coloured  urine ;  these  symptoms  continue  for 
about  three  days,  when  there  is  a  supervention  of  the 

Eruptive  stage. — The  eruption  first  comes  out  in 
small  red  spots  or  points,  which,  in  the  course  of  forty- 
eight  hours,  become  rounded  into  pimples  with  vesi 
cles  upon  their  tops  and  slight  depressions  in  the  cen 
tre.  They  show  themselves  first  upon  the  face,  and 
then  in  regular  succession  upon  the  scalp,  neck,  arms, 
breast,  body,  and  lower  extremities,  requiring  about 
twenty-four  hours  for  the  full  development  of  the  erup- 


FEBRILE    CUTANEOUS    DISEASES.  213 

tion.  After  this  period,  there  is  a  marked  remission 
of  all  the  febrile  symptoms,  which  continues  for  three 
or  four  days,  when  the 

Maturing  or  suppurative  period  commences.  There 
is  now  a  renewal  of  the  febrile  disturbance  still  more 
violent  than  at  first,  which  commonly  continues  during 
the  remaining  course  of  the  disease.  This  period  con 
tinues  from  three  to  five  days,  when  the  serous  fluid 
within  the  pustules  acquires  a  purulent  character, 
becoming  thick  and  yellow.  On  the  tenth  or  eleventh 
day,  the  pustules  burst,  giving  vent  to  the  matter 
which  collects  upon  the  surface  of  the  pock,  forming 
hard  dark  scabs  or  crusts,  which  in  a  few  days  fall  off, 
leaving  the  skin  scurfy  and  sometimes  pitted. 

Now  commences  the  period  of  exsiccation,  which  oc 
cupies  from  three  to  five  days  ;  after  which,  if  the  ma 
lady  has  pursued  a  moderate  course,  the  morbid  symp 
toms  all  subside,  and  convalescence  ensues.  Thus  it 
will  be  perceived,  that  the  regular  course  of  the  dis 
ease  occupies  about  fifteen  days  ;  this  course,  however, 
is  subject  to  modifications  from  a  great  variety  of 
causes,  such  as  the  supervention  of  pneumonia,  bron 
chitis,  ophthalmia,  abdominal  inflammations,  disease 
of  the  glands,  retrocession  of  the  eruption,  &c. 

In  the  confluent  variety,  the  primary  fever  is  of  a 
more  violent  character,  the  eruptive  period  more  irre 
gular,  usually  commencing  at  the  end  of  two  days 
from  the  onset  of  the  malady  ;  there  are  often  spas 
modic  twitchings  of  the  muscles,  at  or  previous  to  the 
appearance  of  the  pustules,  the  secondary  or  suppu 
rative  fever  frequently  assumes  a  typhoid  form,  saliva 
tion  occurs  about  the  period  of  the  eruption,  after 
which  the  tongue,  mouth  and  throat  become  dry  and 
dark,  pocks  form  in  the  mouth,  throat,  larynx,  pharynx, 
rectum,  and  urethra,  and  occasionally  symptoms  mani 
fest  themselves  which  indicate  a  high  degree  of  ma 
lignancy.  The  face  is  often  much  swollen  and  dis 
figured  from  the  pustules  running  into  each  other,  so 
that  the  eyes  become  entirely  closed,  and  the  nostrils 
obstructed.  The  matter  of  the  pustules  is  of  a  dusky 
colour,  and  is  sometimes  so  acrid  as  to  irritate  the  sur 
rounding  skin. 

What  has  been  denominated   varioloid,  is  nothing: 


214  FEBRILE    CUTANEOUS    DISEASES. 

more  or  less  than  an  exceedingly  mild  form  of  small 
pox,  modified  by  previous  vaccination,  or  some  other 
accidental  influence.  The  primary  fever  is  very  mild, 
the  eruption  distributed  over  the  body  in  patches,  the 
suppurating  process  slight  and  imperfect,  attended 
with  little  or  no  secondary  fever. 

Causes. — All  agree  that  variola  proceeds  from  a 
specific  morbific  poison,  sui  generis.  There  are,  how 
ever,  causes  constantly  in  operation,  which  exert  a 
powerful  influence  in  modifying  or  aggravating  the 
character  of  the  malady,  respecting  the  nature  of 
which,  authors  are  not  so  well  acquainted.  At  some 
periods,  smallpox  is  characterized  by  a  high  degree  of 
putridity,  the  symptoms  assuming  a  low  typhoid  form, 
and  a  majority  of  the  cases  proving  speedily  fatal  in 
spite  of  all  remedial  measures.  At  other  seasons  we 
may  have  a  predominance  of  pulmonary  or  cerebral 
symptoms,  attended  with  a  high  grade  of  synochal 
fever,  and  requiring  a  very  different  course  of  treat 
ment  from  the  form  above  mentioned.  Again  it  may 
run  its  course  in  a  regular  and  moderate  manner, 
without  serious  complication  from  disturbance  of  any 
capital  organ,  and  demanding  but  little  aid  from  re 
medial  agents. 

Some  writers  have  supposed  that  these  different 
modifications  were  owing  to  certain  occult  condi 
tions  in  the  atmosphere,  and  also  tha,t  the  existence 
at  the  same  time  of  other  epidemics,  has  a  material 
influence  over  the  character  and  progress  of  small 
pox.  This  is  doubtless  true ;  but  there  are  other 
causes  more  under  our  control,  which  are  of  no  less 
importance,  as  predisposing  agents  to  the  more  vio 
lent  forms  of  the  malady.  The  most  prominent  of 
these,  are,  small  and  ill-ventilated  dwellings,  a  lack 
of  healthy  and  nutritious  food,  want  of  cleanliness, 
insufficient  clothing,  immoderate  use  of  ales,  and  im 
pure  liquors,  and  the  pernicious  custom  of  crowding 
together  in  the  same  apartments,  a  number  of  indi 
viduals,  who  thus  inhale,  a  good  part  of.  the  time,  a 
vitiated  and  unhealthy  air. 

The  fatality  of  the  disorder,  when  it  seizes  upon 
this  degraded  class,  indicates  the  importance  of  the 
influences  fust,  enumerated,  in  aggravating  the  char- 


FEBRILE    CUTANEOUS    DISEASES.  215 

acter  of  the  malady.  Does  it  not,  then,  behoove  the 
guardians  of  the  public  health,  during  the  prevalence 
of  contagious  affections,  to  look  well  to  these  dele 
terious  agencies,  and  purge  their  towns  of  the  filth, 
the  dissipation,  and  the  other  corruptions  of  these 
hot-beds  of  contagion  ? 

Therapeutics. — The  following  are  the  ordinary  me 
dicines  used  in  the  treatment  of  smallpox,  namely, 
aconite,  belladonna,  rhus  tox.,  vaccinin,  variolin,  sulphur, 
opium,  mercurius,  bryonia,  pulsatilla,  nux  vom.,  carbo 
veg.,  arsenicum. 

Aconite,  second  or  third  dilution,  is  the  proper  me 
dicine  during  the  primary  fever,  provided  the  attack 
is  regular,  and  there  exists  no  tendency  to  inflamma 
tion  or  congestion  of  any  important  organ. 

In  case  the  eruption  is  slow  in  making  its  appear 
ance,  or  the  process  should  be  attended  with  great  in 
ternal  oppression,  either  rhus  or  sulphur,  at  the  third 
attenuation,  may  be  exhibited — a  dose  every  three  or 
four  hours. 

Belladonna  is  the  specific,  when,  during  any  part 
of  the  malady,  inflammation  or  congestion  attacks 
the  brain.  In  cases  of  this  description,  this  remedy 
exercises  a  two-fold  effect ;  first,  by  its  special  action 
upon  the  cerebral  organs,  and  second,  by  its  power  of 
forcing  and  of  retaining  the  eruption  upon  the  sur 
face.  The  third  dilution  may  be  used  in  these  in 
stances — one  drop  every  two  hours  until  amelioration 
of  the  symptoms  is  evident. 

Dr.  Liedbeck  of  Stockholm  considers  tart,  antim. 
our  most  valuable  remedy  in  smallpox.  When  taken 
in  large  doses,  it  produces  dryness,  heat  and  redness 
in  the  throat,  internal  eruptions,  large  pustules  (with 
depressions  in  their  centres)  in  the  mouth,  throat,  la 
rynx,  and  trachea :  therefore,  Dr.  L.  infers,  that  "  it 
is  as  much  the  specific  remedy  for  the  smallpox,  ac 
cording  to  homoeopathic  principles,  as  mercury  is  that 
for  syphilis."  The  second  trituration  may  be  used  — 
one  grain  every  two  to  six  hours,  as  circumstances  re 
quire. 

Sulphur  at  the  commencement  of  the  attack,  and 
about  the  period  of  desiccation,  will  often  prove  ex 
ceedingly  serviceable  in  determining:  the  eruption  to 


216  FEBRILE    CUTANEOUS    DISEASES. 

the  surface,  and  in  disposing  it  to  progress  kindly.  In 
individuals  who  suffer  from  a  psoric  taint,  it  cannot 
well  be  dispensed  with.  It  may  be  administered  at 
the  third  trituration,  in  grain  doses,  and  repeated 
sufficiently  often  to  ensure  the  kindly  progress  of  the 
eruption. 

Vaccinin  and  variolin  have  been  highly  extolled 
within  the  past  three  or  four  years,  as  a  remedy  in 
all  stages  of  this  affection.  It  is  said,  that,  by  the 
use  of  these  agents,  variola  is  rendered  a  very  mild 
and  harmless  disease.  It  is  claimed  by  those  who 
have  made  considerable  use  of  them,  that  all  of  the 
stages  of  the  malady  are  shortened  in  duration,  and 
that  a  majority  of  the  cases  thus  treated,  resemble 
varioloid  more  than  real  smallpox.  These  medicines 
may  be  used  in  the  form  of  trituration,  of  the  third 
attenuation. 

Bryonia  will  be  called  for  if  pneumonic  symptoms 
obtain.  This  remedy  will  also  prove  serviceable  in 
typhoid  forms,  attended  with  gastric  or  biliary  de 
rangements. 

Bryonia  may  be  administered  in  mild  cases,  at  the 
third  dilution,  and  in.  severe  congestive  forms  at  the 
first — a  drop  every  two  or  three  hours  in  water. 

Mcrcurius  viv.,  third  trituration,  should  be  admin 
istered,  if  salivation,  ulcerated  throat,  or  diarrhoea 
with  bloody  stools,  and  tenesmus,  occur.  It  is  also  a 
remedy  of  value  during  the  suppurative  stage,  and  in 
the  ophthalmias  which  often  accompany  and  succeed 
the  variolous  attack. 

Opium,  at  the  third  dilution,  will  always  be  appro 
priate  whenever  coma,  and  nervous  sensibility,  ster 
torous  respiration,  convulsive  movements,  and  im 
paired  muscular  action  supervene  during  the  progress 
of  the  malady. 

In  cases  of  great  malignancy,  with  a  gangrenous 
tendency,  and  other  symptoms  evincing  a  low  typhus 
grade,  carlo  veg.,  acid,  nit.,  acid,  mur.,  or  arsenicum, 
may  prove  serviceable  when  all  hopes  from  other 
remedies  have  been  abandoned.  From  the  first  to 
the  third  attenuations  should  be  employed  in  these 
instances.  The  age,  sex,  temperament,  and  the  pe- 


FEBRILE    CUTANEOUS    DISEASES.  217 

culiar  circumstances  connected  with  each  particular 
case,  must  determine  the  proper  strength  of  the  medi 
cine  and  the  frequency  of  its  repetition. 


SECTION  IV, 

VARICELLA. CHICKENPOX. 

Diagnosis. — There  are  a  few  points  of  similarity 
between  the  milder  cases  of  smallpox  and  the  more 
severe  forms  of  varicella,  which  require  an  acute  ob 
server  to  discriminate  between  them  during  the  early 
part  of  an  attack.  Both  diseases  commence  with  a 
similar  primary  fever,  which  continues  until  the  erup 
tion  makes  its  appearance  ;  the  pustules  in  both  in 
stances  resemble  each  other ;  both  are  likewise  conta 
gious,  and  communicable  by  inoculation. 

At  the  eruptive  period,  however,  an  attentive  ob 
server  will  perceive  that  the  resemblance  usually 
ceases,  for  the  pustules  of  variola  make  their  appear 
ance  in  a  uniform  manner,  first  on  the  face,  then  suc 
cessively  upon  the  neck,  arms,  breast,  body,  and  lower 
extremities,  occupying*  usually  but  twenty-four  hours 
for  the  completion  of  the  eruption,  while  the  pustules 
of  varicella  come  out  in  repeated  series,  first  upon 
the  breast,  then  upon  the*  face,  head,  arms,  body,  and 
lower  extremities,  and  require  three  or  four  days 
before  the  eruption  is  complete.  Therefore,  we  often 
observe  during  the  progress  of  the  latter,  some  vesi 
cles  drying  up,  some  in  a  state  of  partial  development, 
while  others  are  but  making  their  first  appearance. 
The  vesicles  of  chickenpox  contain  a  whitish  or  yel 
lowish  lymph,  which  seldom  advances  far  towards 
the  suppurating  stage  ;  and  even  in  those  cases  where 
pus  is  formed,  there  is  never  any  secondary  or  suppu- 
rative  fever,  as  in  variola. 

Causes. — Varicella,  like  the  other  contagious  dis 
orders,  is  a  distinct  affection,  and  proceeds  from  a 
peculiar  specific  cause.  This  is  apparent,  from  the 
fact  that  inoculation  with  varicellous  matter  never 
gives  rise  to  any  other  malady  than  varicella  itself. 

It  is  not  only  a  much  milder  disease  than  smallpox, 
or  varioloid,  but  is  of  much  shorter  duration,  running 
10 


218  FEBRILE    CUTANEOUS    DISEASES. 

its  course  generally  in  six  or  seven  days,  when  the 
pocks  all  disappear,  leaving  smooth  surfaces. 

Therapeutics. — Varicella,  as  it  commonly  occurs, 
requires  no  medicinal  treatment:  a  due  regard  to  diet, 
and  avoidance  of  exposure  to  cold,  dampness,  &c., 
being  only  necessary  to  ensure  its  safe  progress. 

In  cases  where  the  malady  assumes  unusual  sever 
ity,  manifested  by  a  high  grade  of  febrile  excitement, 
determinations  of  blood  to  the  brain,  lungs,  or  abdom 
inal  organs,  then  the  medicines  which  are  homoeo 
pathic  to  the  existing  symptoms  may  be  administered. 

The  remedies  which  have  been  most  frequently 
used  in  these  cases,  are,  aeon.,  caff.,  bell.,  mere.,  rhus 
tox.,  and  sulph.  The  strength  of  the  medicines,  as 
well  as  the  repetitions  of  doses,  the  same-  as  under 
modified  smallpox. 

SECTION  V. 

MILIARIA. MILIARY    FEVER. 

Diagnosis. — This  disease  is  ushered  in  with  lassi 
tude,  slight  creeping  chills,  pain  in  the  loins  and  lower 
extremities,  oppression  at  the  precordia,  cough,  gene 
ral  uneasiness,  more  or  less  heat  and  thirst,  rapid 
pulse,  and  high-coloured  urine.  These  precursory 
symptoms  continue  about  fiv%  days,  when  a  very  fine 
eruption,  resembling  millet  seeds,  makes  its  appear 
ance  on  different  parts  of  the  body.  The  little  vesi 
cles  which  compose  this  eruption  are  round,  hard,  and 
transparent,  becoming  after  a  time  opaque.  As  they 
are  about  coming  out,  there  is  an  itching,  stinging, 
and  burning  sensation  in  the  skin,  the  oppression  at 
the  chest  and  stomach  is  increased  in  severity,  and,  in 
general,  a  profuse  perspiration  of  a  disagreeable,  sour 
odour,  breaks  out  over  the  whole  surface.  After  two 
or  three  days  the  vesicles  become  opaque,  then  soon 
dry  up  and  fall  off  in  the  form  of  scurf. 

Some  writers  consider  miliary  fever  as  a  purely 
symptomatic  affection,  while  others,  with  equal  tenaci 
ty,  maintain  that  it  often  occurs  idiopathically.  Ac 
cording  to  my  own  opinion,  it  is  not  at  all  improbable 
that  it  may  be  dependent  upon  some  latent  miasm, 
which  only  requires  an  exciting  cause,  like  puerperal 


FEBRILE  CUTANEOUS    DISEASES.  219 

fever,  heating  and  stimulating  ptisans,  undue  expo 
sure  in  heated  and  close  rooms,  &c.,  to  call  it  into 
action.  I  am  confirmed  in  this  opinion  from  the  fact, 
that  in  nearly  every  case  with  which  I  have  been 
made  acquainted,  where  the  eruption  has  retroceded, 
whether  by  improper  use  of  external  lotions,  or  other 
wise,  there  has  been  a  supervention  of  some  serious 
internal  disorder. 

If  this  view  of  the  cause  of  the  malady  be  correct, 
the  therapeutical  indications  are  evident,  and  the  pru 
dent  physician  will  use  every  effort  which  our  specific 
medicines  afford,  to  aid  nature  in  casting  off  the  poi 
son  from  the  system  through  the  medium  of  the  skin. 

Therapeutics. — In  conjunction  with  our  internal 
remedies,  it  is  essential  that  the  patient  be  kept  in  a 
dry  apartment,  of  uniform  temperature,  and  be  con 
fined  to  a  strict  dietetic  regimen.  By  these  means, 
we  shall  prevent  the  retrocession  of  the  rash  from 
the  sudden  application  of  external  cold,  and  avoid 
those  unpleasant  complications  which  errors  in  diet 
are  so  apt  to  induce. 

A  strict  adherence  to  the  above  rules,  with  an  oc 
casional  dose  of  aconite,  third  dilution,  will  generally 
suffice  for  the  cure  of  this  complaint. 

After  the  eruption  has  manifested  itself,  if  the  pa 
tient  is  troubled  with  a  train  of  nervous  symptoms, 
like  sleeplessness,  general  uneasiness,  partial  loss  of 
power  over  the  voluntary  muscles,  spasmodic  twitch- 
ings,  and  constant  desire  to  change  position,  a  dose  of 
the  sixth  dilution  of  hyoscyamus  may  be  given,  and 
repeated  as  circumstances  require. 

Should  the  brain  become  affected  in  any  stage  of 
the  disease,  belladonna  may  be  exhibited  in  the  same 
manner  as  advised  under  measles. 

Chamomela,  at  the  tenth  potency,  should  always  be 
administered  when  infants  and  children  are  the  sub 
jects  of  attack.  If  the  malady  commences  with  strong 
febrile  excitement,  this  medicine  may  be  preceded  by 
aconite. 

Bryonia  is  also  highly  recommended  in  cases  of 
miliaria  in  infants  and  parturient  women.  It  may  be 
administered  in  the  same  manner  as  bell. 

Ipecacuanha  will  apply  when  the  eruption    is   ac- 


220  FEBRILE    CUTANEOUS    DISEASES. 

companied  with  laborious  and  noisy  respiration,  nau 
sea,  or  vomiting,  groaning,  aversion  to  food,  chilli 
ness,  alternating  with  flashes  of  heat,  and  sweet,  in 
sipid  taste.  The  third  trituration  should  be  employed 
— one  grain  every  four  or  six  hours  until  the  symp 
toms  yield. 

SECTION    VI. 

ROSEOLA. 

Diagnosis. — This  is  one  of  the  mildest  and  least 
dangerous  of  all  the  eruptive  fevers.  It  is  character 
ized  by  an  eruption  or  efflorescence  of  a  rose  colour, 
preceded  and  accompanied  by  some  slight  symptoms 
of  febrile  disturbance.  The  rash  shows  itself  on  the 
third  or  fourth  day  of  the  fever,  and  comes  out  in  dis 
tinct  and  irregular  spots  upon  different  parts  of  the 
surface,  or  the  spots  run  together,  giving  to  the  skin 
an  almost  uniform  redness.  The  cuticle  is  neither 
elevated,  nor  is  there  any  appearance  of  papulae ; 
but  a  simple  blush  of  a  rose  colour,  characterizes  the 
eruption,  and  serves  as  a  mark  of  distinction  between 
it  and  that  of  other  diseases  of  this  kind.  The  appear 
ance  of  the  rash  is  often  attended  with  itching  and 
tingling,  which  are  present  more  or  less  until  the  erup 
tion  vanishes,  which  is  usually  in  five  or  six  days,  with 
out  desquamation  of  the  cuticle  or  any  unpleasant 
after  symptoms. 

Causes. — Roseola  is  for  the  most  part  confined  to  in 
fants  and  females.  It  arises  from  undue  exposure  to 
cold,  after  having  been  confined  in  a  warm  room,  in 
digestible  food,  dentition,  gastro-intestinal  irritation, 
and  the  abuse  of  stimulating  infusions,  cathartics,  &c. 

Therapeutics. — Rigid  dietetic  regulations,  a  moder 
ate,  dry,  and  equal  temperature,  mental  and  physical 
rest  and  quietness,  and  an  entire  exclusion  of  all  "  herb 
teas,"  and  such  other  "  domestic  remedies,"  so  called, 
as  are  commonly  suggested  by  the  officious  ignorance 
of  old  women.  A  regard  to  these  rules  will  suffice  to 
secure  the  patient  from  any  ill  consequence  of  this  na 
turally  mild  and  simple  affection. 


FEBRILE    CUTANEOUS    DISEASES.  221 


SECTION  VII. 

URTICARIA. NETTLE   RASH. 

Diagnosis. — The  primary  symptoms  of  urticaria  are, 
languor,  oppression,  and  sickness  at  stomach,  foul 
tongue,  bitter  taste,  giddiness,  creeping  chills,  succeeded 
by  preternatural  heat  of  skin  and  thirst.  During  the 
early  period  of  the  disease,  elevated,  circular,  and 
florid  spots  or  weals,  each  with  a  whitish  spot  or  point 
in  its  centre,  appear,  sometimes  in  only  one  part  of  the 
body,  at  other  times  generally  diffused  over  the  whole 
surface.  These  weals  are  attended  with  an  exceed 
ingly  annoying  itching,  stinging,  and  burning  sensa 
tion,  somewhat  resembling  the  stings  of  nettles.  The 
itching,  as  well  as  the  febrile  excitement,  is  always 
worse  in  the  evening  or  during  the  night ;  but  when 
the  eruption  is  upon  the  surface,  the  nausea  and  dis 
tress  at  the  stomach  abate,  and  do  not  return  until 
another  eruptive  period,  unless  there  is  a  sudden  re 
trocession  of  the  weals. 

In  some  instances  the  eruption  appears  suddenly 
without  any  febrile  or  other  premonitory  symptoms, 
and  without  any  apparent  exciting  cause.  At  other 
times,  certain  articles  of  food,  like  shell-fish,  porgies, 
esculent  vegetables,  acid  fruits,  or  stimulants  like  wine, 
spirits,  hot  ptisans,  condiments,  or  frictions  upon  the 
skin,  seem  to  become  its  exciting  causes.  It  usually 
terminates  in  a  few  days,  but  now  and  then  it  persists 
many  months,  sometimes  apparent  upon  the  skin,  at 
others  suppressed. 

"  Its  sudden  disappearance  without  leaving  a  trace 
behind,  and  its  equally  sudden  reappearance,  are  quite 
characteristic.  Inclination  is  also  present  in  all  the 
varieties  of  this  disease,  and  vomiting  frequently  oc 
curs  as  a  crisis." — (Schrocn.) 

Some  nosologists  have  divided  this  malady  into  two, 
and  some  into  four  varieties ;  and  others,  like  Bate- 
man,  and  a  few  of  the  older  writers,  have  gone  so  far 
as  to  recognise  and  describe  seven :  but  these  fine  and 
arbitrary  distinctions  are  not  founded  in  nature,  and 
therefore  offer  no  aid  in  diagnosis  ;  while,  on  the  other 
hand,  there  is  danger  that  they  may  confuse  and  em- 


222  FEBRILE    CUTANEOUS    DISEASES. 

barrass  the  inexperienced  practitioner.  We  know  that 
the  eruption  is  very  irregular  in  regard  to  the  periods 
of  its  appearance,  and  also  in  the  size,  form,  general 
aspect,  and  diffusion  of  the  weals,  yet,  we  see  no  neces 
sity  for  complicating  our  classification  with  so  many 
varieties,  for  we  might  with  as  much  propriety  go 
on  with  divisions,  adinfinitum,  as  to  stop  after  having 
described  six  or  seven  genera,  since  the  most  acute 
nosologist  will  scarcely  be  able  to  discover  any  two 
cases  presenting  precisely  the  same  symptoms  in  all 
respects. 

If,  however,  we  were  to  adopt  any  classification,  it 
would  be  that  of  Schroen,  who  distinguishes  two  forms 
of  the  malady,  the  acute  and  the  chronic.  Under  the  first 
form,  he  includes  :  first,  urticaria  maculosa,  or  spots  of 
different  degrees  of  redness,  attended  with  sensation  of 
formication  and  intense  itching  ;  second,  urticaria  vesi- 
cularis,  or  vesicular  prominences,with  empty  and  almost 
transparent  apices ;  third,  urticaria  tuberosa,  or  hard, 
tense,  and  painful  tuberosities,  generally  appearing  in 
the  night.  Amongst  the  chronic  varieties,  he  ranks  urti 
caria  evanida,  resembling  the  urticaria  tuberosa,  ap 
pearing  on  exposure  to  cold,  and  disappearing  on  the 
application  of  warmth.  This  variety  sometimes  con 
tinues  for  weeks,  and  even  months. 

Causes. — We  entertain  the  opinion  that  the  remote 
cause  of  nettle  rash  consists  of  a  specific  miasm, 
either  generated  within  the  organism,  or  introduced 
from  without,  and  which  is  liable  to  be  roused  into 
action  by  numerous  exciting  causes.  The  proofs  of 
this  are  numerous,  and  we  think  satisfactory  ;  for  if  it 
were  merely  an  effect  or  symptom  of  one  of  the  various 
exciting  causes,  like  indigestible  food,  certain  kinds  of 
fish,  acid  fruits,  vegetables,  wines,  liquors,  &c.,  it  would 
disappear  as  soon  as  the  exciting  cause  wras  with 
drawn,  and  all  irritation  from  this  source  obviated  ; 
but  in  very  many  instances  no  such  result  takes  place, 
and  after  the  noxious  article  has  been  entirely  re 
moved,  and  the  part  previously  deranged  restored  to  its 
usual  normal  condition,  there  is  a  persistence  of  the 
urticaria  for  months,  and  even  years  ;  it  appearing  and 
disappearing  at  frequent  intervals,  without  the  slight 
est  apparent  reason. 


FEBRILE    CUTANEOUS    DISEASES.  223 

Another  fact  which  sustains  the  position  we  have 
advanced,  is,  that  if  the  eruption  be  suddenly  repelled 
by  the  use  of  lotions,  or  cathartics,  serious  internal 
disorders  frequently  supervene  as  a  consequence  of 
the  retrocession,  which  terminate,  if  the  weals  are  not 
reproduced  either  spontaneously  or  artificially,  in  disso 
lution.  A  painful  case,  illustrative  of  this  position, 
came  under  my  observation  a  few  years  since.  The 
patient  was  a  lovely  and  highly  interesting  young 
lady,  who  from  some  slight  exciting  cause  was  af 
flicted  with  urticaria,  although  previously  she  had  re 
mained  for  many  years  in  excellent  health.  The 
malady  annoyed  her  by  turns  for  more  than  three 
months,  when,  from  the  application  of  a  lead-water 
lotion,  the  external  symptoms  suddenly  vanished, 
leaving  in  their  place  wandering  pains  in  the  chest 
and  side,  some  cough,  fits  of  oppression  at  the  chest, 
and  difficulty  of  breathing.  These  symptoms  of  pul 
monary  disturbance  continued  to  increase  until  she 
was  pronounced  by  two  eminent  physicians  of  a 
neighbouring  city  to  be  past  cure,  with  tubercular 
consumption.  About  this  period  the  case  came  under 
my  charge,  in  what  seemed  to  be  the  last  stages  of 
consumption,  Notwithstanding,  however,  the  un 
promising  condition  of  affairs,  my  patient  slowly  but 
gradually  recruited,  so  that  in  six  or  seven  months  the 
abscess  which  had  existed  in  one  lobe  of  her  lungs 
was  healed,  and  the  lungs,  with  her  whole  system, 
were  restored  to  a  comparatively  sound  and  healthy 
state.  In  this  condition  she  continued  for  nearly  two 
years,  when  a  second  attack  of  urticaria  supervened, 
affording  still  farther  relief  for  a  few  days,  from  all 
remaining  difficulties,  when  the  rash  permanently 
disappeared.  From  this  time  her  symptoms  were  all 
aggravated,  her  old  complaints  returned,  the  lungs 
became  again  ulcerated,  so  that  in  a  few  months  the 
malady  advanced  to  a  fatal  termination.  Is  this  an 
isolated  instance  ?  Without  doubt,  the  experience  of 
almost  every  physician  could  furnish  one  or  more 
cases  of  the  same  description. 

This  example  offers  conclusive  proof  to  my  own 
mind,  that  an  intimate  connection  existed  between  the 
two  diseases,  and  that  whenever  the  rash  was  upon 


FEBRILE    CUTANEOUS    DISEASES. 

the  surface,  nothing  disturbed  the  lungs ;  while  the 
moment  retrocession  ensued,  pulmonary  symptoms 
manifested  themselves.  If  urticaria  is  a  purely  local 
disease,  depending  upon  a  distention  or  spasm  of  the 
extreme  cutaneous  vessels,  how  can  the  suppression  of 
such  local  inflammation  affect  so  seriously  internal 
organs  ? 

It  must  be  confessed,  that  our  knowledge  respecting 
the  causes  and  intimate  nature  of  cutaneous  affec 
tions,  is  at  present  quite  limited ;  but  when  we  take 
into  consideration  the  fact  that  so  many  internal  con 
stitutional  maladies  take  their  exit  through  the  sur 
face  in  the  form  of  eruption,  we  are  constrained  to 
believe  that  this  is  almost  uniformly  only  a  symptom 
of  some  internal  constitutional  disorder. 

Therapeutics. — As  it  is  of  the  first  importance  in  all 
cutaneous  diseases,  that  the  eruption  should  be  urged 
and  retained  upon  the  surface,  in  order  that  the  miasrn 
may  not  fall  upon  any  vital  organ,  we  should  select 
our  remedies  chiefly  from  those  which  exercise  a  spe 
cific  action  upon  the  skin. 

Another  point  of  no  less  importance  in  the  manage 
ment  of  eruptive  fevers,  consists  in  securing  for  the 
patient  a  dry,  moderate,  and  equable  temperature. 
This  precaution,  combined  with  cleanliness,  and  a 
placid  and  composed  frame  of  mind,  will  always  aid 
us  materially  in  our  therapeutical  measures. 

The  medicines  which  are  the  most  appropriate  for 
the  treatment  of  this  complaint  are,  aeon.,  sulph.,  dulc., 
rhus.,  calc.,  carb.,  lycop.,  nat.  mur.,  acid,  nit.,  puls., 
ignat.,  ipecac. 

Aconite  will  only  be  required  in  those  cases  which 
are  attended  with  undue  febrile  action.  It  may  be 
administered  as  advised,  under  measles. 

Sulphur. — This  medicine  should  always  be  prescrib 
ed  in  cases  occurring  in  individuals  of  a  marked  scro 
fulous  dyscrasia,  when  the  following  symptoms  obtain. 

External  Indications. — General  appearance  of  debi 
lity  ;  pale,  sallow,  and  sickly  expression  of  face  ;  red 
ness  of  the  margins  of  the  eyelids  ;  swellings  of  the 
glands  of  the  neck. 

Physical  Sensations. — Eruption  and  violent  itchings 
occurring  in  the  night,  from  the  heat  of  the  bed,  and 


FEBRILE    CUTANEOtTS    DISEASES.  225 

occasionally  from  exposure  to  cold  air  ;  great  sensi 
tiveness  to  cold  ;  dizziness  and  pains  in  the  head  ; 
spasmodic  twitchings  of  the  eyelids  ;  bad  taste  in  the 
mouth  ;  nausea ;  pyrosis ;  weakness  and  oppression 
at  the  chest. 

Mental  and  moral  symptoms. — Melancholy  ;  sadness  ; 
irritability. 

Administration. — One  grain  of  the  third  trituration 
in  two  ounces  of  distilled  water, — a  dessert  spoonful 
once  in  twelve  hours. 

Dulcamara  is  useful  in  urticaria,  which  proceeds 
from  taking  cold,  and  is  attended  with  nausea,  vomit 
ing,  oppression  at  the  stomach,  heat  of  skin,  thirst, 
bitter  taste,  diarrhoea,  and  great  general  uneasiness. 
The  symptoms  are  aggravated  at  night,  during  repose, 
and  by  the  heat  of  a  room  ;  but  they  disappear  in  the 
open  air. 

Administration. — A  drop  of  the  third  dilution,  in  a 
small  quantity  of  water,  may  be  given  once  in  six  to 
twelve  hours. 

Rhus  tox. — Eruption,  attended  with  itching  and 
burning  during  inaction,  or  on  entering  a  room  from 
the  open  air  ;  disappearance  of  the  weals,  on  exer 
cise,  followed  by  shifting  rheumatic  pains,  pains  and 
pressure  in  the  stomach,  difficult  respiration,  short 
breath  in  the  evening,  agitation  and  anguish.  This 
medicine  is  particularly  applicable  in  urticaria  vesi- 
cularis. 

Administration. — Same  as  dulcamara. 

Calcarca  carbonica  is  indicated  in  cases  where  the 
rash  vanishes  on  going  into  the  fresh  air,  and  excited 
by  the  application  of  cold  water  :  face  yellow,  upper 
lip  swollen,  skin  rough  and  covered  with  goose  pim 
ples,  stunning  lateral  pains  in  the*head,  with  nausea 
and  vertigo  at  night,  or  in  the  morning,  on  waking, 
with  faintness  ;  anxiety,  anguish,  apprehension. 

Remarks. — Calcarea  carbonica  is  suitable  in  obsti 
nate  chronic  urticaria,  especially  when  occurring  in 
scrofulous  or  cachectic  constitutions.  It  is  sometimes 
necessary  to  persist  in  the  use  of  this  remedy  for 
several  weeks. 

Administration. — A  drop  of  the  third  dilution  in  an 
ounce  of  water, — a  dessert  spoonful  once  or  twice  in 
the  twenty-four  hours. 

10* 


226  FEBRILE  CUTANEOUS   DISEASES. 

Lycopodium. — Rash  and  itching  during  repose,  head 
ache  in  the  afternoon  or  at  night,  smarting  of  the  eyes 
by  candle-light,  nausea  when  in  a  hot  room,  relieved 
in  the  air,  silent  and  peevish. 

Administration. — Same  as  calcarea  carbonica, 

Natrum  mur.,  at  the  sixth  potency,  may  be  pre 
scribed,  when  there  are  languor,  uneasiness,  nausea, 
headache,  weakness  when  lying  down  at  night,  re 
lieved  on  rising  in  the  morning,  eruption  coming  out 
after  violent  exercise. 

Nitric  acid,  third  dilution,  will  be  proper  for  patients 
of  a  consumptive  or  scrofulous  habit,  afflicted  with 
debilitating  night  sweats,  weak,  enfeebled,  subject  to 
haemorrhages  from  the  bowels,  lungs,  nose,  &c.,  and 
rash  caused  by  exposure  to  cold  air.  A  drop  should 
be  prescribed  two  or  three  times  daily. 

Pulsatilla,  sixth  dilution,  when  the  elevations  are 
redder  than  the  skin,  when  the  itching  is  of  a  burning 
or  pricking  character,  worse  at  night  in  bed,  in  a  hot 
room,  or  by  scratching  ;  better  in  the  open  air ;  worse 
every  other  evening ;  heaviness  and  disposition  to 
numbness  in  the  limbs;  great  sensibility  to  the  open  air. 

Ignatia,  sixth  dilution,  is  particularly  adapted  to 
attacks  occurring  in  nervous  and  hysterical  females : 
the  eruption  is  brought  out  by  exercise,  and  is  often 
preceded  by  nervous  symptoms  ;  there  is  also  fulness 
and  pressure  of  the  head,  with  sparks  before  the  eyes  ; 
also  sighing,  and  irregular  respirations. 

Ipecacuanha,  third  trituration,  is  useful  in  cases  at 
tended  with  excessive  vomiting,  oppression  at  the 
chest,  and  dyspnea  ;  it  is  also  a  valuable  remedy  in 
asthma  from  suppressed  urticarias. 

Other  remedies  worthy  of  consideration  are,  arseni- 
cum,  balsam  copaibce,  iodine  and  bryonia  in  the  chronic 
forms ;  and  in  the  acute  varieties,  clematis,  staphysagria, 
and  belladonna.,  for  urticaria  vesicularis ;  urtica  and 
hepar  sulphur,  for  urticaria  tuberosa  ;  mercurius,  iodine, 
aurum  mur.  and  sepia,  for  urticaria  maculosa. 

Administration.— The  above  remedies  may  be  given 
dissolved  in  pure  water.  They  may  be  repeated  in 
six,  eight,  or  twelve  hours,  according  to  the  urgency  of 
the  symptoms.  In  all  cases  of  this  description,  where 
a  latent  miasm  is  suspected  to  exist,  a  persevering  and 
judicious  course  of  anti-psoric  treatment,  should  be 


FBBB1LB  CtJTAlCEOffS  DISEASES.  231 

% 

Causes. — There  is  much  difference  of  opinion  re 
specting  the  causes  of  erysipelas.  Some  attribute  it 
to  a  local  cutaneous  vice  ;  some  to  a  degeneration  of 
the  blood  in  consequence  of  improper  food,  abuse  of 
stimulants,  &c. ;  some  to  a  derangement  of  the  biliary 
organs  ;  some  to  atmospheric  influences  ;  while  others 
entertain  the  opinion  that  it  is  dependent  upon  a  pe 
culiar  dyscrasia  which  is  constantly  present  as  a  pre 
disposing  cause.  This  opinion  appears  to  us  reason 
able  ;  but  whether  this  dyscrasia  is  in  all  instances 
hereditary,  or  whether  it  may  be  acquired  by  intem 
perance,  unwholesome  food,  or  from  contaminated  air, 
we  are  as  yet  unable  to  determine. 

The  more  common  exciting  causes  of  erysipelas 
are,  debility  and  loss  of  resisting  power,  from  disease, 
abuse  of  stimulants,  violent  emotions  of  the  mind,  un 
due  exposure  to  cold,  certain  states  of  the  atmosphere, 
accouchement,  disordered  stomach  and  bowels,  confine 
ment  in  close  and  crowded  apartments,  and  wounds. 

Eberle  asserts  that  "  the  inflammation  which  is  pro 
duced  by  the  recent  leaves  of  the  rhus  toxicodendron, 
is  strictly  of  an  erysipelatous  character."  This,  how 
ever,  is  an  error,  for  although  a  close  similarity  exists 
between  the  two  inflammations,  the  careful  observer 
will  be  able  to  distinguish  decided  marks  of  differ 
ence. 

Therapeutics. — The  important  medicines  in  the 
treatment  of  erysipelas,  are,  rhus  toxicodendron,  bella 
donna,  aconite,  sulphur,  opium,  graph.,  arsenicum,  carbo 
vegetabilis,  mere.,  phosphorus,  pulsatilla,  acid  phospho 
rus,  acid  nitric,  sit,  china,  hep.  sulph.,  lack.,  bryonia, 
chamomela,  clem.,  and  euphorb. 

Rhus  toxicodendron.  —  External  indications. — In 
flammation  confined  to  the  skin  ;  numerous  vesicular 
blotches,  attended  with  itching  and  burning  sensation  ; 
swelling  and  redness  of  the  face,  worse  in  the  eyelids, 
around  the  eyes,  and  in  the  lobules  of  the  ears,  at 
tended  with  burning  and  itching ;  swelling  in  the 
scalp  ;  erysipelatous  inflammation  of  the  scrotum  in 
new-born  children  ;  distinct  or  confluent  vesicles,  con 
taining  an  acrid,  limpid,  or  yellowish  fluid,  with  red 
ness  of  the  skin  over  the  whole  surface  of  the  body ; 
partial  or  entire  closure  of  the  eyelids ;  swelling  and 


FfMJRJLE  <2tTTAWGOUS 

hardness  of  the  alee  nasi ;  gangrenous  ulcers ;  hot 
and  dry  skin  ;  rapid  and  full  pulse  ;  urine  small  in 
quantity,  dark  and  turbid. 

Physical  sensations. — Burning,  itching,  and  stinging 
of  the  affected  parts,  aggravated  by  scratching  ;  irri 
tation  and  sometimes  excoriation  of  the  skin  from  con 
tact  of  the  vesicular  discharge  ;  the  itching  and  burn 
ing  sensations  worse  in  the  evening ;  stiffness  and 
sense  of  immobility  in  the  swollen  parts  ;  bruised  feel 
ing  in  the  limbs  and  back  ;  general  sensation  of  heat, 
both  externally  and  internally,  occasionally  interrupted 
by  slight  rigours  ;  mouth  filled  with  saliva,  or  dry, 
with  or  without  thirst ;  dryness  and  obstruction  of  the 
nose,  relieved  by  drafts  of  cold  air,  or  by  being  fan 
ned  ;  painful  pulsations  in  the  internal  ears,  when 
resting  on  the  affected  side  ;  scalp  swollen  and  painful 
to  the  touch  ;  eyes  painful  on  motion  ;  dull  heavy  pain 
in  the  head,  aggravated  by  motion  or  stooping. 

Mental  and  moral  symptoms. — Obtuseness  of  intel 
lect,  stupefaction,  and  weakness  of  memory ;  sadness, 
anxiety,  and  despondency  towards  evening,  and  during 
the  night ;  nightly  delirium. 

Administration. — A  drop  of  the  second  or  third  di 
lution  in  water,  once  in  two  to  four  hoars. 

Remarks. — Ruoff  and  Schroen  consider  rhus  particu 
larly  applicable  in  vesicular  erysipelas  which  is  con 
fined  to  the  skin  ;  but  if  symptoms  indicative  of  se 
rious  cerebral  disorder  are  present,  they  prefer  bella 
donna.  It  has  been  used  with  success  in  infantile 
erysipelas. 

Belladonna. — External  indications. — Skin  swollen, 
red,  hot,  and  painful ;  cheeks,  eyelids,  nose,  lips,  and 
forehead,  swollen,  tense,  shining,  and  painful  to  the 
touch  ;  eyes  red,  prominent,  and  glistening,  or  dull  and 
cloudy ;  pupils  dilated  or  contracted ;  whole  head 
swollen  and  painful  ;  obstruction  of  the  nostrils  ;  in 
flammation  and  enlargement  of  the  parotid  glands ; 
hardness  of  hearing  ;  redness  and  swelling  of  the 
tonsils  and  throat;  urine  scanty,  dark,  yellow,  or 
reddish,  clear  or  turbid  ;  vesicular  inflammation,  with 
intense  febrile  excitement ;  tongue  and  lips  dry ;  sor- 
des  upon  the  teeth  ;  occasionally  spasms,  tremblings, 
and  rigidity  of  the  limbs ;  pulse  generally  full  and 
quick. 


FEBRILE    CUTANEOUS    DISEASES. 

Physical  sensations.  —  Tension  and  pressure,  or 
sharp,  throbbing  pains  in  the  head  ;  scalp  very  pain 
ful,  especially  on  pressure  ;  violent  heat  and  burning: 
of  the  inflamed  parts  ;  dryness,  smarting,  or  burning 
of  the  eyes ;  disordered  vision  ;  stitching  and  throb 
bing  pains  in  the  ears,  both  externally  and  internally ; 
roaring  and  humming  in  the  ears  :  mouth  and  throat 
dry,  hot,  and  painful ;  sticking  and  burning  sensation 
in  the  throat  when  swallowing ;  aversion  to  food  and 
drinks,  or  violent  thirst  for  cold  drinks  ;  bad  taste  in 
the  mouth,  bitter  eructations,  and  other  signs  showing- 
biliary  and  gastric  derangement ;  short,  anxious,  and 
difficult  inspirations  ;  great  weariness  and  uneasiness  ; 
pains  worse  in  the  afternoon  and  at  night,  and  ag 
gravated  by  contact  or  movement. 

Mental  and  moral  symptoms. — Vertigo,  confusion  of 
ideas,  or  loss  of  consciousness,  or  delirium,  violent  at 
night,  but  moderate  during  the  day ;  or  melancholy, 
despondent,  and  apathetic. 

Administration. — A  drop  of  the  third  dilution  in 
water  every  two  or  three  hours,  according  to  the 
severity  of  the  symptoms. 

Remarks. — It  was  chiefly  from  the  employment  of 
belladonna  and  aconite,  that  Listen  produced  the  suc 
cessful  results  in  the  North  London  Hospital,  and  in 
private  practice,  to  which  we  have  already  alluded. 
We  believe  it  to  be  our  most  valuable  remedy  in  those 
cases  which  have  been  excited  by  intemperance  and 
violent  emotions  of  the  mind.  It  is  applicable  also  in 
nearly  all  cases  of  erysipelas  \vhere  there  exists  pro 
minent  cerebral  disorder.  In  these  cases,  should  it 
not  cover  all  of  the  important  symptoms,  we  may  give 
some  other  appropriate  medicine  in  alternation. 

Whenever  febrile  symptoms  are  strongly  pro 
nounced,  and  there  exists  a  decidedly  augmented  ac 
tion  of  the  circulatory  vessels,  aconite  will  be  required, 
either  alone  or  in  alternation  with  some  other  remedy. 
It  should  be  used  in  the  first,  second,  or  third  dilutions 
— a  drop  in  water  as  often  as  the  exigencies  of  the 
case  may  demand. 

Opium  is  indicated  in  those  cases  which  supervene 
during  pneumonia,  typhoid,  and  other  fevers,  and  pre 
sent  the  following  signs  :  profound  coma  ;  stertorous 


234  FEBRILE    CUTANEOUS    DISEASES. 

respiration  ;  eyes  dull  and  watery  ;  pupils  dilated  and 
immovable  ;  general  appearance  stupid  and  besotted  ; 
spasmodic  motions  in  different  parts  of  the  body  ; 
pulse  slow  and  feeble,  or  slow,  intermittent,  and  full  ; 
inability  to  rouse  the  patient.  The  second  or  third 
dilution  may  be  employed — a  drop  every  half  hour 
until  an  impression  is  produced. 

When  ulcers  have  formed,  and  there  is  a  disposition 
to  gangrenous  degeneration,  we  must  refer  to  ars., 
carb.,  veg.,  sulph.,  lack.,  euphorb.,  sil,  clam.,  acid.,  nit. 
and  acid  phos. 

In  erysipelas  phlegmonodes,  when  the  inflammation 
is  extending  into  the  cellular  tissue,  our  best  remedies 
are  bell.,  graph.,  hep-sulph.,  mere.,  phos.,  sil.,  and 
sulph. 

If  the  inflammation  exhibits  a  tendency  to  shift  from 
place  to  place,  and  is  attended  with  gastric  or  intesti 
nal  derangement,  and  constantly  shifting  pains,  pulsa- 
tilla  will  prove  specific. 

Bryonia  has  been  strongly  recommended  when  the 
inflammation  takes  place  about  the  joints,  and  is  ac 
companied  by  rheumatic  pains. 

China  will  often  prove  serviceable  during  convales 
cence  from  severe  and  protracted  attacks,  when  the 
energies  of  the  system  have  been  exhausted,  and 
there  is  great  irritability  of  the  nervous  system.  Some 
of  the  signs  which  point  to  this  medicine,  are  emacia 
tion,  osdema  of  the  limbs,  deficiency  of  animal  heat, 
pale  countenance,  great  debility,  ringing  in  the  ears, 
disturbed  sleep. 

External  applications  to  the  affected  surfaces,  in  the 
form  of  blisters,  and  of  nit.  of  silver,  have  sometimes 
been  employed  with  success  by  gentlemen  of  the  old 
school,  and  as  they  are  in  accordance  with  our  prin 
ciple  of  cure,  it  becomes  us  to  give  them  all  due  atten 
tion. 

Respecting  the  administration  of  the  remedies  above 
enumerated,  we  suggest,  as  a  general  rule,  the  em 
ployment  of  the  first,  second,  and  third  attenuations  ; 
but  in  cases  of  infants  and  young  children,  we  may  go 
up  to  the  tenth  or  twelfth  dilution.  In  acute  cases, 
the  dose  should  be  repeated  once  in  two  to  four  hours  ; 
but  in  the  chronic  varieties,  two  or  three  times  daily 
will  suffice. 


FEBRILE    CUTANEOUS    DISEASES.  235 


SECTION    IX. 

THE    PLAGUE. 

The  plague  is  said  to  resemble  in  many  respects 
malignant  typhus  ;  the  only  phenomena  which  serve 
to  distinguish  it  from  this  fever,  being  the  numerous 
buboes  and  carbuncles  which  appear  on  the  body. 
By  many  it  is  supposed  to  be  really  nothing  more  or 
less  than  a  genuine  typhus  fever,  rendered  peculiarly 
putrid  and  malignant  by  the  atmospheric  and  other 
influences  which  prevail  in  Egypt  and  the  other  orien 
tal  nations  in  which  it  has  prevailed.  As  in  the  worst 
grades  of  typhus,  maculae,  petechiae,  diarrhoea,  haemor 
rhages  from  the  bowels,  &c.,  generally  supervene  in 
the  advanced  stages  of  the  disorder,  in  addition  to  the 
buboes  and  carbuncles. 

Our  knowledge  in  relation  to  this  disease  is  so 
limited,  it  being  derived  solely  from  the  imperfect  de 
scriptions  we  have  seen,  by  other  writers,  that  no  at 
tempt  will  here  be  made  to  detail  its  symptoms.  But 
if  we  may  be  allowed  to  judge  of  its  nature  from  those 
phenomena  which  seem  to  be  characteristic,  we  sup 
pose  the  following  remedies  will  correspond  with  its 
manifestations,  and  prove  to  it  homosopathic,  namely : 
arsen.,  acid  nit.,  rhus  tox.,  veratrum,  mere.,  bell,  chin., 
ipecac.,  carb.  veg. 


236 


CHAPTER  XXI. 

OF   THE    CHRONIC   CUTANEOUS    DISEASES. 
VESICULAR  VARIETIES. 

SECTION  X. 

HERPES TETTER. 

Diagnosis. — The  eruption  consists  of  groups  of  small 
vesicles,  situated  upon  red  and  inflamed  bases,  and 
separated  from  each  other  by  sound  portions  of  skin. 
As  the  vesicles  increase  in  size,  the  colourless  fluid 
which  they  contained  in  the  first  instance,  becomes 
gradually  opaque,  and  in  two  or  three  weeks  dries  up 
into  thin  crusts  which  scale  off.  When  the  eruption 
makes  its  appearance,  there  is  an  unpleasant  burning 
and  crawling  sensation,  which  soon  settles  into  a  deep- 
seated,  and  in  some  cases,  severe  pain.  It  may  be 
confined  to  a  single  point,  or  extend,  in  clusters  of  dif 
ferent  sizes,  over  a  large  surface. 

Another  variety  of  tetter,  is  often  observed  to  com 
mence  in  the  form  of  broad  and  irregular  clusters  of 
small  vesicles,  sometimes  seated  on  swollen  and  in 
flamed  bases,  and  shortly  becoming  confluent ;  or  the 
eruption  may  appear  in  distinct  groups  and  unattend 
ed  with  any  inflammation  or  swelling  of  the  surround 
ing  skin.  In  the  first  form,  when  the  inflammation  is 
somewhat  active,  the  vesicles  often  burst  and  dis 
charge  their  contents,  leaving  troublesome  ulcers  at 
their  bases.  This  variety  is  sometimes  described  under 
the  term  eczema,  or  humid  tetter. 

According  to  Bateman,  most  kinds  of  herpes  pass 
through  a  "  regular  course  of  increase,  maturation, 
and  decline,  and  terminate  in  about  ten,  twelve,  or 
fourteen  days.  The  eruption  is  preceded,  when  it  is  ex 
tensive,  by  considerable  constitutional  disorder,  and  is 
accompanied  by  a  sensation  of  heat  and  tingling,  and 
sometimes  by  severe  pains  in  the  parts  affected." 

Herpes  has  been  subdivided  into  many  different  spe 
cies,  on  account  of  presenting  some  points  of  distinc 
tion  when  attacking  different  parts  of  the  body. 


THE    CHRONIC    CUTANEOUS    DISEASES,    ETC.  237 

Thus,  when  the  vesicles  appear  upon  the  lips  during 
colds,  fevers,  and  inflammations  of  the  mucous  mem 
branes  of  the  pulmonary  or  digestive  apparatus,  the 
disease  is  termed  herpes  labialis.  The  eruption  in  this 
instance,  is  usually  of  a  more  inactive  and  unhealthy 
character,  than  when  it  occurs  in  other  parts  of  the 
body.  The  matter  which  escapes  from  the  vesicles 
is  purulent  or  sanious,  and  concretes  into  black 
crusts. 

When  the  eruption  consists  of  a  narrow  belt  of  ve 
sicles,  extending  partly  around  the  body,  or  over  the 
shoulder,  it  receives  the  appellation  of  herpes  zoster, 
or  shingles. 

Another,  and  very  common  form,  is  thus  described 
by  Schroen  :  "  An  inflamed  red  ring,  commonly  per 
fectly  circular,  and  upon  which  numerous  small  glo 
bular  vesicles  appear,  which,  though  at  first  perfectly 
transparent,  soon  become  turbid  ;  these  burst,  and  dis 
charge  a  thin  fluid,  which  forms  a  slight  lamellated  crust 
that  soon  becomes  detached,  leaving  a  bright  red 
mark.  Sometimes  the  fluid  is  absorbed,  and  the  vesi 
cles  fade  and  fall  off  in  thin,  scurfy  exfoliations.  The 
duration  of  the  disease  is  about  seven  or  eight  days  for 
each  ring ;  but  as  successive  rings  appear  and  go 
through  a  similar  course,  it  may  last  between  two  or 
three  weeks."  Schoenlein  supposes  that  a  repulsion  of 
this  eruption  predisposes  the  patient  to  fungus  hozma- 
todes.  This  variety  is  called  herpes  circinnatus,  or  ring 
worm. 

Other  subdivisions  have  been  made  into  herpes  prce- 
puti alls,  herpes  iris,  herpes  phlyctcenodes,  &c.;  but  since 
the  nature  of  the  malady  is  the  same  in  all  these  va 
rieties,  and  as  the  modifications  which  occur  are  de 
pendent  in  a  great  measure  upon  the  peculiar  struc 
ture  of  the  affected  parts,  we  do  not  deem  it  necessary 
to  enter  into  a  more  minute  exposition  of  the  details 
pertaining  to  each  species. 

Causes. — Errors  in  diet ;  immoderate  use  of  fat,  rich, 
and  indigestible  food  ;  a  morbid  condition  of  the  cu 
taneous  excretion ;  local  irritations  from  external  in 
juries,  and  the  application  of  acrid  substances.  It 
has  been  observed  that  those  who  have  suffered  from 
attacks  of  syphilis,  scrofula,  scurvy,  or  who  have  taken 


238  THE    CHRONIC    CUTANEOUS    DISEASES,    ETC. 

much  mercury,  are  most  prone  to  the  disease.  In  these 
cases,  a  predisposition  is  established  in  the  skin,  so 
that,  from  slight  causes,  herpetic  eruptions  are  ex 
cited. 

Therapeutics. — When  the  eruption  attacks  the  face, 
head,  body,  or  extremities,  our  best  remedies  are,  sul 
phur,  calcarea  carb.,  silicea,  carbo  veg.,  sepia,  rhus  tox., 
belladonna,  lycopodium,  iodine,  graphites,  aurum  mur. 

Herpes  of  the  lips  should  be  treated  with  arsenicum, 
acid  phos.,  graphites,  phosphorus,  hepar  sulphur. 

If  the  eruption  appears  upon  the  scrotum  or  prepuce, 
the  appropriate  medicines  are  mercurius,  arsenicum, 
sulphur,  calcarea  carb.,  conium,  rhus  tox. 

Nearly  all  cases  which  occur  may  be  cured  by  sul 
phur,  calcarea  carb.,  sepia,  and  mercurius  ;  but  should 
these  remedies  disappoint  us,  there  will  be  no  diffi 
culty  in  making  an  appropriate  selection  from  the 
medicines  first  enumerated. 

Administration. — For  the  most  part,  we  rely  upon 
the  first,  second,  and  third  attenuations  ;  and  prescribe 
drop  doses  of  the  dilutions,  or  grain  doses  of  the  tritu- 
rations,  twice  daily  until  a  satisfactory  amendment  is 
evident. 

SECTION    XI. 

PEMPHIGUS. 

Diagnosis — This  is  also  a  vesicular  affection,  cha 
racterized  by  the  appearance  of  single  vesicles  of 
large  size  upon  the  legs,  and  occasionally  upon  other 
parts  of  the  body.  '  The  vesicles  are  filled  with  a  yel 
low  or  straw-coloured  fluid,  and  are  seated  upon  an 
inflamed,  hard,  and  red  base.  This  disease  occurs 
during  the  course  of  fevers,  or  in  old  and  enfeebled 
persons,  after  undue  exposure  to  cold,  or  improper  in 
dulgence  in  stimulants  or  indigestible  food.  "  I  have 
frequently  seen,"  wrrites  Mackintosh,  *'  large  bullae 
take  place  in  the  course  of  slight,  as  well  as  severe 
fevers  ;  but  instead  of  considering  them  thereby  en 
titled  to  any  specific  character,  I  have  always  looked 
upon  their  occurrence  as  an  accidental  circumstance, 
and  have  made  no  difference  in  the  treatment  of  the 
original  disease.  The  appearance  of  the  vesicles  is 


THE    CHRONIC    CUTANEOUS    DISEASES,    ETC.  239 

sometimes  preceded  by  slight  chills,  followed  by  tran 
sient  flushes  of  heat,  and  other  signs  indicative  of  mild 
constitutional  disturbance.  In  these  instances  the  in 
teguments  at  the  base  of  the  vesicles  are  hard, 
swollen,  and  painful.  The  ordinary  duration  of  the 
eruption  is  from  one  to  two  weeks  ;  but  in  some  in 
stances  the  vesicles  continue  to  appear  for  months. 

Therapeutics. — Sulphur,  rhus,  arsenicum,  dulcamara, 
iodine,  acid  nit.,  and  mercurius. 

Administration. — The  medicines  may  be  employed 
in  the  same  manner  as  advised  in  herpes. 

SECTION  XII. 

POPULAR    VARIETIES. LICHEN. 

Diagnosis. — Many  kinds  of  this  malady  are  de 
scribed  by  writers,  although  the  general  character  of 
the  eruption  is  in  all  instances  the  same.  Willan 
gives  us  seven  different  forms  ;  and  other  authors  de 
scribe  even  a  greater  number.  But  the  propriety  of 
these  minute  subdivisions  is  very  questionable,  since 
some  slight  distinctions  might  be  made  in  almost  all 
cases  which  occur,  and  thus  lead  to  a  very  extensive 
and  inconvenient  classification. 

The  eruption  consists  of  numerous  small  papillae 
upon  the  breast,  arms,  and  limbs,  in  the  first  instance, 
which  afterwards  spread  over  the  whole  surface  of 
the  body,  attended  with  tingling  and  itching,  especi 
ally  when  exposed  to  heat,  or  when  covered  up  warm 
ly  in  bed.  The  eruption  is  generally  preceded  by  slight 
febrile  excitement,  and  symptoms  of  gastric  or  intes 
tinal  disorder.  The  bases  of  the  papillae  are  red,  in 
flamed,  and  painful,  but  they  do  not  often  suppurate, 
or  become  filled  with  serum,  but  continue  about  eight 
or  nine  days,  when  they  dry  up,  and  fall  off  in  the 
form  of  scurf. 

The  eruption  which  is  so  often  seen  in  infants 
during  the  period  of  dentition,  and  known  as  "  the  red 
gum,"  is  a  form  of  lichen.  In  these  cases  the  colour  of 
the  papillae  may  be  red  or  white. 

Sometimes  the  eruption  appears  in  the  palms  of  the 
hands,  the  arms  and  legs,  when  it  receives  the  vulgar 
appellation  of  salt  rheum 


240  THE    CHRONIC    CUTANEOUS    DISEASES,  ETC. 

The  eruption  now  and  then  comes  out  in  a  mild 
form  upon  the  trunk  or  extremities,  attended  with 
heat,  and  troublesome  itching  on  becoming  heated,  or 
from  rubbing  or  scratching,  but  entirely  unattended  by 
febrile  excitement.  This  variety  is  familiarly  known 
under  the  designation  of  prickly  heat. 

Causes. — Irritation  of  the  stomach  and  intestines 
from  errors  in  diet,  worms,  and  teething.  Also  pro 
tracted  exposure  to  a  hot  fire ;  going  into  the  cool  air, 
after  long  exertion  while  in  a  profuse  perspiration  ; 
or,  sometimes  from  entering  a  hot  apartment,  after 
having  been  exposed  for  a  long  time  to  intense  cold. 

Therapeutics. — The  following  medicines  will  suffice 
for  the  cure  of  all  forms  of  this  complaint :  sulphur, 
graphites,  calcarea  carb.,  sepia,  iodine,  antimonium  tart., 
copaiba  bah.,  acid  phos.,  chamomela,  dulcamara,  rhus 
tox.,  hepar  sulphur. 

Administration. — Same  as  for  herpes. 

PRURIGO. 

Diagnosis. — Prurigo  is  believed  by  some  authors  to 
be  a  severe  form  of  lichen.  The  papillae  are,  how 
ever,  larger,  "  more  isolated  and  distinct,  and  scattered 
over  larger  surfaces"  than  those  of  that  affection.  The 
eruption  is  sometimes  of  a  red  or  pinkish  colour,  at 
other  times  white,  like  the  surrounding  skin,  and  at 
tended  with  the  most  intense  itching  and  stinging. 
The  papillae  are  most  commonly  distributed  about  the 
labia  pudendi,  but  the  disease  is  not  unfrequently  ob 
served  in  other  parts  of  the  body. 

The  causes  and  treatment  are  the  same  as  those 
described  under  lichen. 

SECTION  XIII. 

PUSTULAR     VARIETIES  I SCABIES. PSORA. ITCH. 

Diagnosis. — The  great  diversity  of  appearances 
which  this  disease  is  constantly  presenting,  renders  a 
complete  description  almost  impossible.  It  has 
been  regarded  by  some  writers  of  note,  as  papular, 
by  others  as  pustular,  but  by  the  majority  as  vesi 
cular.  It  consists  of  a  pustular,  papular,  or  vesicular 
eruption,  generally  situated  between  the  fingers,  on 


THE    CHRONIC    CUTANEOUS    DISEASES,    ETC.  241 

the  wrists,  near  the  joints,  but  sometimes  extending 
over  the  whole  body.  The  eruption  is  attended  with 
almost  constant  itohing,  which  is  aggravated  by 
scratching,  or  by  the  heat  of  a  fire,  or  of  the  bed.  The 
disorder  is  decidedly  contagious  in  its  character,  and 
according  to  Schroen,  li  never  gets  well  of  itself  ;  but 
will  last  for  years,  and  may  exist  upon  the  skin  a  whole 
life-time,  if  its  cure  is  neglected."  This  author  re 
cognises  four  distinct  forms  : 

1.  Scabies  sicca,  or  pimply,  or  dry  itch,  most  com 
mon  in  adults.  This  form,  when  repelled,  often  gives 
rise  to  "  nervous  apoplexy,  ascites,  or  chronic  hydro- 
cephalus,  and  it  is  best  treated  by  sulphur,  mercury, 
causticum,  carbo  vcg.,psoricum,  sepia,  lachesis,  and  vera- 


2.  Scabies  vesicularis,  or  common  itch,  occurring  most 
commonly   in   highlands,  —  very    rarely  in    low   and 
swampy  districts.    When  this  form  is  abruptly  repelled, 
it  gives  rise  to  serious  affections  of  the  cerebral  and 
pulmonary  organs,  and  to  the  nervous  system.     Sul 
phur  is  undoubtedly  the   appropriate    specific,   and 
should  be  given  at  the  first  trituration.     In  obstinate 
cases  we  may  employ  one  or  more  of  the  following 
medicines:    psoricum,  sepia,  hepar  sulph.,  arsenicum, 
rhus,  mercuriusj  iodine,  copaibaj,  calcarea  carb. 

3.  Scabies  purulenta,  appearing  in  the  form  of  yellow 
and  prominent  pustules  between  the  fingers  and  toes. 
In  this  form,  Schroen  advises  sulphur,  antimonium  tart., 
sepia,  cicuta,  lycopodium,  and  mercurius. 

4.  Crusta  serpiginosa,  —  "  This  form  resembles  crustea 
lactea,  but  is  marked  by  the  appearance  of  small  vesi 
cles   behind  the  ears,  which  burst,   forming   a   thin 
dark-coloured  scab,  from  which  an  acrid  fluid  is  se 
creted."     The  face,  neck,  arms,  and  trunk  eventually 
become  involved.     For  the  cure  of  this  form  Schroen 
advises  sulphur,  clematis  erec.,  calcarea    carb.,  lycopo- 
dium,  and  arsenicum. 

Causes.  —  By  many  the  disease  is  supposed  to  be 
owing  to  the  presence  in  the  skin  of  minute  animal- 
cula,  of  the  species  acarus  scabei.  It  has  likewise 
been  attributed  to  want  of  cleanliness,  and  the  use  of 
unwholesome  food. 

Administration.  —  The  remedies  should  be  given  at 

11 


242  THE    CHRONIC    CUTANEOUS    DISEASES,    ETC. 

the  first  or  second  attenuation,  and  repeated  two  or 
three  times  a  day  until  the  eruption  disappears.  In 
recent  cases,  Hartmann,  Schroen,  and  Schmid,  employ 
the  tinctures  and  the  first  dilutions  ;  but  in  obstinate 
cases  they  employ  from  the  third  to  the  sixth  attenua 
tions. 

SECTION  XIV. 

ECTHYMA. 

Diagnosis. — This  disease  originates  from  a  morbid 
condition  of  the  skin,  which  supervenes  during  the 
course  of  eruptive,  and  other  fevers,  venereal  diseases, 
scrofula,  scurvy,  &c.  The  pustules  are  of  considera 
ble  size,  seated  upon  swollen,  bright  red.  and  painful 
bases,  and  never  running  together,  but  always  pre 
serving  a  distinct  character.  After  a  few  days  the 
pustules  become  covered  with  hard,  and  dark  or 
greenish  scabs,  which,  in  one  or  two  weeks,  dry  up 
and  disappear.  Ecthyma  has  been  subdivided  into 
several  distinct  varieties,  on  account  of  some  trifling, 
and  as  we  believe,  unimportant  modifications  which 
the  eruptions  occasionally  present,  from  peculiarities 
of  age,  constitution,  disease,  and  habits  of  life.  The 
most  common  of  these  varieties  are : 

1.  Ecthyma  vulgare,  "consisting  of  a  partial  erup 
tion  of  small,  hard  pustules,  on  the  neck,  shoulders,  or 
extremities,  which  is  completed  in  about  three  days. 
They  enlarge  and  inflame,  form  pus,  and  then  scabs. 
These  eventually  dry,  fall  off,  and  leave  no  mark  be 
hind.     They  are  chiefly  seen  in  young  persons  whose 
health  has  been  impaired." 

2.  Ecthyma  luridum,  with  pustules,  "  larger,  more 
diffused,  more  repeated,  and  fixed  upon  a  hard,  eleva 
ted  base  of  a  peculiar  dark  red  colour/'* 

2  Kr.thyma  infantile,  occurring  generally  in  in 
fants  of  delicate,  or  scrofulous  constitutions,  or  in  those 
whose  systems  have  been  enfeebled  by  abuse  of  drugs. 

4.  Ec'hyma  cachecticum,  peculiar  to  individuals 
who  are  suffering  under  a  venereal,  scrofulous,  or 
psoric  taint. 

*  Hall 


THE    CHRONIC    CUTANEOUS    DISEASES,    ETC.  243 

EUPIA, 

Is  another  pustular  affection,  often  resembling  very 
closely  ecthyma.  Bateman  describes  it  thus :  "  an 
eruption  of  flat,  distinct  vesicles,  with  bases  slightly 
inflamed,  containing  a  sanious  fluid,  the  scabs  accu 
mulating,  sometimes  in  a  conical  form,  easily  rubbed 
off,  and  soon  reproduced."  Although  this  author  de 
scribes  the  eruption  as  vesicular,  it  is  now  generally 
conceded  that  the  disease  is  for  the  most  part  pustular. 
The  eruption  may  be  distinguished  from  that  of  ecthy 
ma,  by  the  appearance  of  the  scabs,  and  the  ulcera- 
tions  which  frequently  occur.  Several  varieties  have 
been  described,  but  we  do  not  deem  it  necessary  or 
useful  to  enter  into  a  particular  enumeration  of  all  the 
minute  points  of  difference  in  the  various  cases  which 
present  themselves,  since  the  general  character  of  the 
eruption  is  sufficiently  marked  to  enable  the  careful 
observer  to  detect  its  true  nature  without  difficulty. 

Therapeutics. — The  medicines  usually  employed  in 
the  above  complaints  are,  sulphur,  sepia,  mercurius, 
rhus,  antimonium  tart.,  silicea,  hepar  sulph.,  aurum 
?nur.,  arsenicum,  iodine,  calcarea  carb.,  dulcamara. 

Administration. — Attenuations  and  repetitions  of 
doses,  the  same  as  in  scabies. 

SECTION  XV. 

IMPETIGO. 

Diagnosis. — The  eruption  consists  of  clusters  of 
small  pustules,  vesicular  in  the  first  instance,  but  soon 
becoming  purulent.  After  a  few  days  the  pustules 
burst,  and  thick  and  dark  yellow  scabs  remain.  The 
skin  around  the  pustules  is  somewhat  swollen,  in 
flamed,  and  painful,  and  when  the  secretion  from  the 
ruptured  pimples  is  acrid,  the  patient  is  often  annoyed 
with  an  exceedingly  disagreeable  burning  and  itching 
sensation.  Willan,  Bateman,  Rayer,  Schroen,  and 
several  other  eminent  writers  on  cutaneous  affections, 
recognise  five  different  varieties  : 

1.  Impetigo  figurata,  occurring  generally  in  children 
during  dentition,  and  in  "  young  men  and  women  of 
lymphatic  or  sanguine-lymphatic  temperaments." 
Raver  advises  lycopodium,  sepia,  sulphur,  rhus  tox., 


244  THE    CHRONIC    CUTANEOUS    DISEASES,    ETC. 

graphite,  calcarea  carb.,  dulcamara  and  petroleum  in  this 
form  of  the  disease. 

2.  Impetigo  sparsa. — In  this  variety  the  pustules  are 
isolated,  and  dispersed  over  the  shoulders,  buttocks, 
face,  and  scalp,  or  legs.     It  generally  "  appears  in  the 
fall  and  winter,   and  disappears  in  spring  and  sum 
mer." — (Bateman.)     Mercurius,   sulphur,    cicuta,    and 
lachesis  will  be  found  specific  in  this  form. 

3.  Impetigo  erysipelatodes. — The  eruption  is  usually 
a  disease  of  the  face,  and  bears  some  resemblance  to 
erysipelas  in  the  first  instance,  but  soon  changes  to  a 
pustular  character.     The  scabs   which    form  on  the 
pustules  are  of  a  dirty  yellow  or  greenish  colour,  and 
are  kept  soft  by  the  secretion  which  is  under  them. 
Schroen  considers  belladonna,  rhus  tox.,  mercurius,  and 
arsenicum,the  proper  remedies  for  this  form. 

4.  Impetigo  scabida. — This  is  a  severe  form,  attended 
with  more  inflammation  and  pain  in  the  affected  parts, 
and   more    extensive  ulceration  and  discharge,  than 
either  of  the  other  varieties.     We  may  employ,  hepar 
sulph.,  mercurius,  arsenicum,  and  iodine. 

5.  Impetigo    larvalis,   or   crusta  lac  tea.      "  Common 
amongst  young  sucklings  ;  characterized  by  an  erup 
tion  upon  the  cheek,  of  superficial,  more  or  less  con 
fluent  pustules,  united  in  groups,  attended  with  slight 
itching,   and  followed  by  yellowish  and  green — gen 
erally  thin  and  lamellated,  at  times,  however,  with 
thick  and  soft  crusts,  that  when  loosened,  leave  a  red 
and  inflamed  surface,  which   is  quickly  covered  with 
new  crusts.     The  best  remedies  are,  sulphur  and  rhus 
tox."  (Schroen,)  or  dulcamara,  lycopodium,  and  sepia, 
(Knorre,)  or  graphites  and  mezereum,  (Lobethal.) 

Administration. — In  the  same  manner  as  in  herpes. 

SECTION    XYI. 

PORRIGO. 

This  is  a  contagious  disorder,  and  presents  itself  in 
the  form  of  "  straw-coloured  pustules,  sometimes  cir 
cumscribed,  sometimes  diffused  ;  generally,  but  not  al 
ways  confined  to  the  head  ;  the  pustules  break  and 
give  issue  to  a  fluid  which  concretes  into  yellowish  or 
brownish,  thin  or  thick,  crusts  or  scabs." — (Hall.) — It 


THE    CHRONIC    CUTANEOUS    DISEASES,    ETC.  245 

commonly  makes  its  appearance  upon  the  scalp  and  face, 
but  may  occur  in  any  other  part  of  the  body.  The  dis 
ease  has  been  subdivided  into  several  different  varieties, 
but  the  divisions  are  of  no  practical  utility,  and  tend 
directly  to  create  confusion  and  embarrassment. 
In  some  constitutions,  the  eruption  becomes  so  exten 
sive  and  severe,  as  to  give  rise  to  troublesome  ulcer- 
ations,  and  considerable  constitutional  disturbance. 
In  cases  of  this  kind,  as  well  indeed  as  in  all  others, 
the  utmost  care  should  be  taken  to  ensure  cleanliness, 
so  that  the  secreted  fluid  shall  not  accumulate,  and 
thus  serve  to  perpetuate  the  disorder.  The  principal 
remedies  are  sulphur,  rhus  toxicodendron,  calcarea,  car- 
bo  vegetabilis,  sepia,  graphite,  and  arsenicum. 

ACNE, 

Is  another  pustular  affection,  making  its  appearance 
generally  upon  the  nose,  face,  forehead,  and  shoulders, 
first  in  the  form  of  a  thickening  redness,  and  indura 
tion  of  the  integuments,  from  which  eventually  pro 
ceed  suppurating  points  or  tubercles.  The  parts  af 
fected  often  acquire  a  depth  of  redness  and  a  con- 
spicuousness  which  much  annoy  the  patient.  Plumbe 
supposes  that  the  malady  consists  in  a  diseased  con 
dition  of  the  sebaceous  follicles,  induced  by  excessive 
indulgence  in  the  pleasures  of  the  table,  sedentary  ha 
bits,  &c.  Sometimes  it  is  violent,  and  extensive  in 
flammation  and  suppuration  occur.  The  remedies 
enumerated  under  porrigo  will  apply  in  it. 

Administration. — The  doses  and  repetitions  of  the 
medicines,  the  same  as  in  scabies. 

SECTION  XVII. 

SQUAMOUS    DISEASES LEPRA. 

Diagnosis. — This  disease  is  characterized  by  the 
appearance  of  spots  of  various  sizes,  with  red  and  in 
flamed  borders,  slightly  raised  above  the  surrounding 
skin,  and  covered  with  scurfy,  bran-like  flakes  or 
scales,  which  are  constantly  falling  off,  to  be  repro 
duced.  In  some  instances,  a  raw  and  tender  surface 
remains  after  the  scales  have  fallen,  attended  with 
severe  itching  and  smarting,  on  rubbing  or  scratching, 


246  THE    CHRONIC    CUTANEOUS    DISEASES,    ETC. 

or  on  exposure  to  a  high  heat.  The  eruption  is  unat 
tended  by  any  febrile  disturbance,  but  is  not  unfre- 
quently  associated  with  scrofulous  or  venereal  taints, 
and  an  impaired  condition  of  the  digestive  apparatus. 
The  causes  which  tend  to  render  the  eruption  severe, 
extensive,  and  permanent,  are  want  of  cleanliness, 
constant  exposure  to  a  hot  sun,  and  unwholesome  food. 

PSORIASIS. 

Mackintosh  regards  psoriasis  as  an  aggravated  form 
of  lepra.  According  to  Hall,  it  "  dinners  from  lepra 
chiefly  in  the  irregular  form,  in  the  diffusion  of  the 
scaly  patches,  and  in  the  absence  of  its  inflamed  bor 
ders,  depressed  centres,  and  regular  oval  or  circular 
forms.  The  subjacent  surface  is  also  more  tender, 
more  easily  denuded,  and  more  prone  to  become  affect 
ed  by  fissures*"  The  disease  attacks  the  scalp,  face, 
the  arms,  the  legs,  the  palms  of  the  hands,  the  lips,  the 
prepuce  and  the  scrotum.  Occasionally  the  inflam 
matory  action  runs  so  high  that  the  parts  become  much 
swollen  and  highly  painful.  In  these  cases  there  is 
usually  a  considerable  secretion  from  the  eruption. 

PITYRIASIS. 

Simple  pityriasis  is  most  commonly  confined  to  the 
hairy  scalp,  and  displays  itself  in  the  form  of  a  su 
perficial  bran-like  scurf,  which  may  easily  be  removed 
by  a  comb  or  a  brush,  but  which  is  speedily  repro 
duced.  In  mild  cases,  and  with  ordinary  care,  the 
disease  may  continue  with  but  slight  annoyance  for 
many  years,  or  it  may  be  roused  into  a  more  active 
and  troublesome  form  by  general  debility,  attacks  of 
eruptive  fever,  and  by  the  relaxing  effects  of  a  hot  cli 
mate. 

Therapeutics. — We  consider  sulphur,  iodine,  conium, 
calcarea,  carbo  vegetabilis  and  sepia,  the  best  remedies 
for  the  above  diseases.  Arsenicum,  graphites,  acid 
nit.,  phosphorus,  lycopodium,  natrum  mur.,  copaibce, 
argenti  nit.,  aurum  mur.,  and  hepar  sulph.,  have  like 
wise  been  employed  with  success. 

Administration. — The  first,  second,  and  third  at 
tenuations  should  be  employed — a  dose  each  day  until 
the  morbid  action  is  subdued. 


247 


CHAPTER  XXII. 

DISEASES   OF    THE    ORGAN'S    AND    TISSUES    CONNECTED 
WITH  THE  DIGESTIVE  SYSTEM. 

SECTION  I. 

GLOSSITIS. INFLAMMATION    OF    THE    TONGUE. 

Inflammation  of  the  tongue  is  by  no  means  a  com 
mon  affection,  but  cases  now  and  then  occur  in  which 
this  organ  is  so  enormously  inflamed  and  swollen,  as 
to  place  the  sufferer  in  imminent  danger  of  suffocation. 
It  may  arise  spontaneously,  with  but  few  and  slight 
premonitory  symptoms  of  its  approach,  or  it  may  pro 
ceed  from  derangements  of  the  stomach,  sudden 
changes  of  temperature,  and  the  application  of  irrita 
ting  or  poisonous  substances.  Generally  it  runs  its 
course  rapidly,  and  if  not  met  by  prompt  and  efficient 
measures,  will  so  fill  the  mouth  and  throat  as  to  sus 
pend  respiration. 

Diagnosis. — Previous  to  the  pain  and  swelling  of  the 
tongue,  the  patient  is  affected  with  slight  chills,  loss 
of  appetite,  lassitude,  indications  of  disordered  stomach, 
dull  pains  in  the  head  and  back,  succeeded  with  throb 
bing  and  aching  pains  in  the  tongue,  heat  of  skin,  and 
rapid  pulse.  The  tongue  now  commences  swelling, 
and  often  progresses,  if  the  inflammation  is  not  ar 
rested,  to  an  alarming  extent.  It  is  usually  red  and 
dry,  but  in  some  instances  continues  moist  through  all 
the  disease. 

Causes. — Derangements  of  the  stomach,  exposure  to 
strong  currents  of  air,  mercurial  salivation,  smallpox, 
the  application  of  irritating  substances,  stings  of  in 
sects,  and  certain  poisons. 

Tfierapeutics. — The  physician  is  sometimes  sum 
moned  to  cases  of  this  description,  where  the  danger 
of  suffocation  is  so  threatening,  as  hardly  to  render  it 
prudent  to  await  the  operation  of  remedies.  In  these 
instances  free  and  deep  incisions  should  be  made  into 
the  substance  of  the  tongue  in  a  parallel  direction, 


248  DISEASES    OF    THE    ORGANS    AND    TISSUES 

which  will  afford  prompt  temporary  relief,  and  thus 
allow  us  time  for  the  action  of  our  specific  remedies. 

The  medicines  which  will  apply  specifically  in  these 
cases  are,  mere.,  bell.,  plumb.,  aur.,  and  hep. 

Mercurius  sol. — External  indications. — Expression 
of  countenance,  anxious  and  terrified  ;  tongue  inflamed, 
swollen,  red,  dry  or  moist  ;  respiration  exceedingly 
difficult ;  pulse  rapid  and  full  ;  constant  inclination 
to  keep  an  upright  position  ;  skin  hot  and  dry. 

Physical  sensations. — Febrile  symptoms ;  heat,  thirst, 
pains  in  the  head,  back  and  limbs  ;  throbbing,  sting 
ing,  or  aching  pains  in  the  tongue  ;  mouth  and  throat 
filled  with  the  swollen  organ,  giving  rise  to  a  dread 
ful  sense  of  suffocation  ;  symptoms  somewhat  aggra 
vated  during  the  night  ;  rapid  sinking  of  strength  ;  re 
spiration  rather  better  in  the  air,  and  on  gentle  motion  ; 
deglutition  partially  or  entirely  suspended. 

Mental  and  moral  symptoms. — Excessive  anguish, 
apprehension,  and  constant  and  insurmountable  dread 
of  immediate  suffocation. 

Administration. — Divide  two  grains  of  the  third  tri- 
turation  into  six  equal  parts — one  powder  dry  upon 
the  tongue  every  half  hour  in  urgent  cases,  until  there 
is  relief  or  a  medicinal  aggravation.  In  less  severe 
cases  the  medicine  may  be  given  once  in  twro,  four,  or 
six  hours,  according  to  the  symptoms. 

Belladonna. — External  indications. — Face  red  ;  eyes 
bloodshot,  or  suffused  ;  tongue  inflamed,  red,  dry,  and 
swollen  ;  violent  pulsations  of  the  carotid  and  tem 
poral  arteries  ;  pulse  rapid  and  bounding. 

Physical  sensations. — Congestion  of  blood  to  the 
head  ;  throbbing  pain  in  the  head  ;  eyes  sensitive  to 
light  ;  skin  hot  and  dry,  thirst  ;  throbbing,  darting,  or 
drawing  pains  in  the  tongue  ;  difficult  and  anxious 
respiration  ;  deglutition  extremely  difficult  or  entirely 
suspended  ;  sense  of  suffocation. 

Mental  and  moral  symptoms. — Great  agitation  ;  fear 
of  death  ;  anxious  and  depressed. 

Administration. — A  drop  of  the  third  dilution  on 
two  grains  of  sugar  of  milk :  divide  into  four  equal 
parts,  and  exhibit  one  dry  upon  the  tongue  once  in 
one,  two,  or  three  hours,  as  the  urgency  of  the  case 
demands. 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  249 

Plumbum  is  appropriate  in  cases  of  chronic  swelling 
of  the  tongue,  with  numbness  and  partial  paralysis. 
Convulsive  tremors  and  general  muscular  debility  are 
other  indications  for*  the  employment  of  this  remedy. 

In  cases  of  glossitis  proceeding  from  the  abuse  of 
mercury,  recourse  may  be  had  to  aurum  muriatic,  and 
hepar  sulph.  If  the  inflammation  be  owing  to  a  wound 
or  injury,  arnica  is  the  proper  remedy. 

SECTION  II. 

TONSILITIS. QUINSY. 

Diagnosis. — Febrile  symptoms,  succeeded  in  a  few 
hours  by  soreness  of  the  throat,  painful  deglutition, 
swelling  and  redness  of  the  tonsils,  uvula,  and  soft 
palate.  As  the  tonsils  continue  to  enlarge,  deglutition 
and  respiration  become  more  difficult,  the  voice  is 
changed,  the  pains  increase  in  severity,  extending 
often  through  the  eustachian  tubes  into  the  ears,  the 
tongue  becomes  covered  with  a  thick  yellow  fur,  there 
is  an  abundance  of  viscid  saliva  on  the  tongue  and 
tonsils,  the  breath  acquires  an  exceedingly  offensive 
odour,  which,  according  to  Mackintosh,  proceeds  from 
sebaceous  matter  escaping  from  the  mucous  follicles. 

The  disease  may  terminate  in  resolution,  suppura 
tion,  or  in  permanent  induration.  When  the  appro 
priate  remedies  are  administered  at  the  commence 
ment,  the  inflammation  usually  resolves  itself  without 
suppuration.  If  no  medicines  are  given,  or  those  only 
which  are  inappropriate,  the  disorder  usually  pro 
gresses  until  suppuration  ensues,  when  an  artificial 
opening  is  made,  or  the  tonsil  bursts  spontaneously, 
and  the  swelling  and  inflammation  gradually  subside. 

Not  unfrequently  the  tonsils  become  affected  with 
chronic  enlargements  and  indurations,  from  frequent 
and  partially  subdued  acute  attacks,  which  prove  ex 
ceedingly  troublesome  by  their  proneness  to  take  on 
acute  inflammation  from  the  slightest  exciting  causes. 

There  is  reason  to  suppose  that  chronic  enlarge 
ments  of  the  tonsils  often  lead  to  coughs  and  expecto 
ration  of  muco-purulent  matter,  which  are  confounded 
with  and  erroneously  attributed  to  chronic  bronchi 
tis,  &c. 

11* 


250  DISEASES    OF    THE    ORGANS    AND    TISSUES 

Causes. — The  predisposing  causes  are  :  scrofulous 
dyscrasia,  irritability,  and  chronic  enlargement  of  the 
tonsils  from  mercurial  salivations,  and  derangements 
of  the  stomach  and  bowels.  The  common  exciting 
causes  are,  cold,  atmospheric  vicissitudes,  wet-feet. 

Therapeutics. — The  best  remedies  for  acute  tonsilitis 
are,  belladonna,  mercurius,  aconite,  baryta  ca?'b.,  nux, 
pulsatilla,  and  hepar  sulph. 

Belladonna. — External  indications. — Cheeks  flushed  ; 
violent  pulsations  of  the  carotids  ;  enlargement  of 
tonsils  perceptible  on  the  outside  of  the  throat ;  ton 
sils,  uvula,  and  soft  palate,  inflamed,  dark,  red,  and 
swollen  ;  tongue  dry,  or  covered  with  a  thick  trans 
parent  and  tenacious  mucus  ;  skin  hot  ;  pulse  full, 
hard,  and  frequent  ;  voice  hoarse,  stifled,  or  sup 
pressed. 

Physical  sensations. — Headache  ;  burning  and  shoot 
ing  pains  in  the  throat  when  swallowing  ;  constant 
inclination  to  swallow  ;  choking  sensation  ;  tonsils 
painful  to  the  touch  ;  putrid  or  bitter  taste  ;  thirst ; 
eyes  sensitive  to  the  light ;  stitches  extending  into  the 
ears  ;  deafness  from  obstruction  of  the  orifice  of  the 
eustachian  tube  ;  burning  fever. 

Mental  and  moral  symptoms. — Uneasiness  and  de 
jection,  worse  at  night,  and  occasionally  delirium. 

Administration. — Two  drops  of  the  third  dilution  to 
two  grains  of  sugar  of  milk.  Divide  into  six  parts 
and  exhibit  one  dry  once  in  two  to  four  hours  as  long 
as  necessary. 

Mercurius. — External  indications. — Offensive,  pu 
trid  odour  from  the  mouth  ;  tongue  covered  with  a  thick 
yellow  fur  ;  mouth  dry  or  filled  with  viscid  saliva  ; 
uvula  elongated  and  red  ;  tonsils  and  soft  palate  dark 
red,  inflamed  and  enlarged  ;  roots  of  the  tongue  red 
and  swollen ;  ulcers  in  the  mouth  and  throat  ;  en 
largement  of  the  parotid  or  submaxillary  glands  ;  pulse 
frequent  and  moderately  full. 

Physical  sensations. — Heat,  alternating  with  chills  ; 
frequent  profuse  sweats  ;  stinging  and  shooting  pain 
in  the  throat,  particularly  when  swallowing  ;  very 
great  difficulty  in  swallowing,  although  frequent 
inclination  ;  glands  of  the  neck  painful  on  motion  of 
the  jaws,  at  sight  of  savoury  food,  or  on  swallowing ; 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  251 

the  pains  and  difficulty  of  deglutition  worse  at  night ; 
pains  darting  through  the  eustachian  tube  to  the  ears 
and  parotid  glands  ;  loss  of  appetite  and  disgust  for 
food  ;  putrid  or  coppery  taste  ;  thirst  for  cold  drinks  ; 
symptoms  mitigated  during  repose  in  bed. 

Mental  and  moral  symptoms. — Morose  ;  dejected  ; 
uneasy ;  out  of  humour. 

Administration. — Divide  four  grains  of  the  third 
trituration  into  six  powders — give  one  dry,  upon  the 
tongue,  once  in  four  to  six  hours  until  an  impression 
is  apparent. 

Aconite  is  a  suitable  remedy  in  cases  of  tonsilitis 
attended  with  a  high  grade  of  arterial  reaction,  painful 
deglutition,  bright  redness  of  the  fauces,  uvula  and 
tonsils,  with  pricking  or  burning  pains  when  swallow 
ing. 

Administration. — A  drop  of  the  third  dilution  to  two 
grains  of  sugar  of  milk.  Divide  into  four  parts  and 
exhibit  one  dry,  once  in  two  hours  until  the  symptoms 
abate. 

Baryta  carb.  maybe  given  in  cases  of  eatarrhal  ton 
silitis,  where  there  is  suppuration  of  the  tonsils,  swol 
len  and  elongated  uvula,  raw  scraping  or  shooting 
pain  on  swallowing,  obstruction,  as  if  by  a  plug  in  the 
throat,  bad  taste,  offensive  breath,  especially  in  the 
morning,  and  discharge  of  sebaceous  matter  from  the 
follicles  of  the  throat. 

Administration. — Same  as  aconite. 

When  derangement  of  the  stomach  appears  to  be 
the  prime  predisposing  cause  of  the  complaint,  and 
when  the  symptoms  of  the  acute  attack  are,  scraping 
pains  during  deglutition,  or  when  inhaling  cold  air ; 
obstruction  from  the  enlarged  tonsils,  choking  and 
spasmodic  contractions  of  the  throat  when  swallowing, 
nux  vomica  is  the  specific  remedy.  It  may  be  admin 
istered  at  the  third  dilution,  by  means  of  sugar,  like 
aconite. 

Pulsatilla  will  apply  in  cases  arising  from  a  chill 
by  being  wet,  wet  feet,  &c.  The  signs  for  this  remedy 
are,  burning,  scraping,  smarting  or  shooting  pains  in 
the  throat  when  swallowing,  deglutition  obstructed 
by  viscid  mucus  which  adheres  to  the  tonsils  and 
fauces,  pains  worse  in  the  afternoon  and  evening,  bitr 


252  DISEASES    OF    THE    ORGANS    AND    TISSUES 

ter  or  saltish  taste  in  the  mouth,  loss  of  appetite,  un 
natural  taste  of  food,  tongue  furred  with  a  thick  yel 
low  coat,  and  breath  offensive. 

Administration. — A  drop  of  the  third  dilution  on  su: 
gar.  Divide  into  four  parts,  and  let  one  be  given  dry, 
once  in  four  hours  until  the  desired  effect  is  produced. 

Hep.  sulphur  has  been  much  employed  by  our  Eng 
lish  brethren,  in  those  habitual  cases  of  inflammation 
and  suppuration  of  the  tonsils,  which  appear  to  owe 
their  origin  to  a  scrofulous  dyscrasia.  This  medicine 
occasionally  arrests  the  disease  and  prevents  suppura 
tion,  after  belladonna,  mercurius,  and  aconite  have 
entirely  failed  to  produce  an  impression.  It  may  be 
given  in  grain  doses,  at  the  third  trituration,  once  in 
two  hours. 

SECTION  III. 

••• 

PAROTITIS. 1HUMF8. 

This  affection  is  classed  by  writers  as  an  epidemic. 
It  is  more  prone  to  attack  children  than  adults,  and 
generally  makes  its  appearance  during  cold  and  damp 
seasons.  Its  cause  is  a  specific  morbific  contagion, 
which  may  be  generated  during  certain  peculiar  con 
ditions  of  the  atmosphere,  or  it  may  be  communicated 
from  the  bodies  of  those  having  the  disorder. 

Diagnosis. — Slight  febrile  disturbance,  followed  by 
swelling  and  pain  in  one  or  both  parotid  glands.  Un 
der  favourable  circumstances  the  local  affection  con 
tinues  to  progress  until  the  end  of  the  fourth  day,  at 
which  time  the  inflammation  and  swelling  have 
reached  their  height :  when  the  tumefaction  and  pain 
gradually  subside,  until  at  the  end  of  about  seven  or 
eight  days  from  the  commencement,  all  traces  of  the 
complaint  have  departed.  As  soon  as  the  inflammation 
has  fairly  declared  itself  in  the  glands,  the  patient  ex 
periences  much  difficulty  and  pain  in  moving  his  jaws, 
masticating,  or  even  at  the  sight  of  savoury  food. 

It  is  highly  important  during  its  progress,  that  there 
be  no  exposure  on  the  part  of  the  patient,  either  to 
cold  or  dampness,  nor  from  any  undue  mental  or  physi 
cal  excitement.  In  this  manner  we  may  guard  against 
those  troublesome  metastasis  to  the  brain,  mamma. 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  253 

and  testes,  which  sometimes  supervene  from  improper 
exposure,  external  applications,  &c. 

Therapeutics. — But  little  medicinal  treatment  is  re 
quired  in  this  malady,  provided  the  precautions  just 
alluded  to  are  heeded  ;  a  few  doses  of  the  sixth  dilution 
of  mercurius  sol.  being  all  that  is  necessary  to  conduct 
the  patient  happily  through  the  attack. 

Sometimes,  however,  coma  and  other  alarming  symp 
toms  of  cerebral  disorder,  suddenly  appear  from  me 
tastasis  of  the  disease  to  the  brain,  which  require  the 
prompt  administration  of  belladonna,  opium,  or  other 
cerebral  specifics.  More  commonly,  however,  the 
metastasis  occurs  to  the  mamma  or  testes,  causing  in 
flammation,  swelling,  induration,  and  occasionally 
suppuration  in  these  glands.  The  remedies  in  these 
cases  are  mere.,  so/.,  bell.,  nux,  puls.,  and  aeon.  See 
the  particular  indications  for  these  medicines  under 
"  Inflammation  of  the  mamma  and  testes." 

SECTION  IV. 

GASTRITIS. INFLAMMATION    OF    THE    STOMACH. 

Diagnosis. — Burning,  pricking,  or  lancinating  pains 
in  the  stomach,  nausea  and  vomiting,  great  soreness, 
tenderness,  and  pain  on  motion  or  pressure,  intense 
thirst  for  cold  drinks,  which  are  ejected  almost  as  soon 
as  swallowed,  affording  some  temporary  relief,  prick 
ing  and  soreness  in  the  throat  and  oesophagus,  tongue 
red  at  the  tip  and  on  the  edges,  and  covered  through 
the  centre  with  a  white  or  yellowish  fur,  position 
mostly  upon  the  back  or  side,  with  the  limbs  drawn 
up  and  the  abdominal  muscles  relaxed,  great  depres 
sion,  anxiety,  and  fear  of  death  ;  pulse  rapid,  sharp, 
contracted,  sometimes  almost  threadlike  ;  bowels  con 
stipated  ;  disgust  for  food  and  warm  drink,  either  of 
which  are  expelled  as  soon  as  received  into  the  stom 
ach  ;  and  in  severe  cases,  delirium,  and  fever  of  a  syno- 
chal  grade.  There  is  an  unusual  fulness  in  the  epi 
gastric  region,  and  often  of  the  abdomen.  As  the  dis 
ease  progresses,  the  extremities  become  cold,  the  fea 
tures  contracted  and  sunken,  the  eyes  glazed  or  suf 
fused,  and  finally  diarrhoea,  cold  sweats,  coma,  and 
convulsions  supervene. 


254  DISEASES    OF    THE    ORGANS    AND    TISSUES 

When  death  occurs,  it  is  usually  caused  by  ulcera- 
tion  or  sphacelation  of  some  portion  of  the  mucous  and 
sub-mucous  coats  of  the  stomach. 

Causes. — Excessive  use  of  highly  seasoned  food, 
stimulating  drinks,  the  introduction  of  irritating  sub 
stances  into  the  stomach,  poisons,  injuries,  and  the 
use  of  emetics,  drastics,  stimulants,  and  other  medici 
nal  poisons  with  which  the  allopathic  practice,  gov 
erned  by  no  scientific  method,  frequently  induces  this 
and  other  diseases,  and  destroys  the  existence  it  is  in 
tended  to  preserve. 

Therapeutics. — The  ordinary  remedies  used  in  the 
treatment  of  gastritis,  are,  arsenicum,  veratrum,  nux, 
pulsatilla,  aconite,  iodium,  ipecacuanha. 

Arsenicum.  —  External  indications.  —  Countenance 
contracted,  sunken,  and  expressive  of  anguish  and 
anxiety  ;  stomach  swollen  and  hot  to  the  touch  ;  po 
sition  upon  the  back ;  respiration  short,  rapid,  and 
suppressed ;  tongue  red  and  clean,  or  red  on  the 
edges  with  a  dirty  fur  in  the  centre  ;  pulse  contract 
ed,  tense,  and  frequent  ;  voice  hoarse,  stifled,  and  sup 
pressed  ;  skin  dry  and  hot,  with  perhaps  cold  and 
clammy  extremities. 

Physical  sensations. — Burning,  sharp,  or  shooting 
pains  in  the  stomach  ;  aggravation  of  the  sufferings 
from  motion,  pressure,  coughing,  and  inspiration ; 
scraping  and  burning  pain  in  the  throat  and  oesopha- 
gus  ;  great  prostration ;  weakness  and  trembling  of 
the  limbs  ;  urgent  thirst  for  cold  drinks ;  persistent 
nausea  and  vomiting  ;  all  food  and  drinks  speedily  and 
violently  rejected  ;  exceeding  tenderness  in  the  epi 
gastric  region  on  pressure  ;  respiration  suppressed  and 
painful. 

Mental  and  moral  symptoms. — Intense  anxiety,  an 
guish,  depression,  and  despair  ;  expectation  of  speedy 
death  ;  sometimes  delirium. 

Administration. — Two  drops  of  the  sixth  dilution  in 
an  ounce  of  water ;  a  dessert  spoonful  once  in  two  to 
four  hours,  until  the  proper  impression  is  made  upon 
the  inflammation. 

Veratrum.  —  External  indications.  —  Hippocratic 
countenance  ;  nose  pointed  ;  eyes  sunken  and  glazed  ; 
lips  bluish  and  dry;  tongue  red  at  the  tip  and  on  the 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM. 

edges,  with  a  dark,  dry  fur  running  through  the  cen 
tre  ;  pulse  quick,  weak,  and  almost  imperceptible  ; 
stomach  and  abdomen  distended  ;  extremities  cold, 
and  covered  with  a  clammy  sweat ;  position  on  the 
back,  with  the  knees  drawn  up ;  hiccough  ;  and  whole 
appearance  indicative  of  extreme  prostration. 

Physical  sensations. — Feeling  of  great  exhaustion  ; 
burning  pain  in  the  stomach  ;  rough,  dry,  and  scrap 
ing  sensation  in  the  throat,  rendering  deglutition  diffi 
cult  and  painful ;  great  soreness  in  the  epigastric  re 
gion  ;  short,  troublesome  cough ;  severe  and  contin 
ued  nausea  and  vomiting  ;  great  dread  of  warm  food 
and  drinks  ;  intense  thirst  for  cold  drinks  ;  inability 
to  retain  anything  upon  the  stomach  ;  spasmodic  con 
tractions  of  the  throat,  oesophagus,  and  abdominal 
muscles  ;  hiccough  ;  painful  respiration. 

Mental  and  moral  symptoms. — Excessive  dejection, 
discouragement,  and  sadness  ;  fear  of  death,  complete 
despair  ;  delirium. 

Administration. — In  urgent  cases  we  may  give  a 
dose  of  the  sixth  dilution,  in  water,  once  in  one  hour, 
until  an  amendment  declares  itself,  or  there  occurs  a 
well  pronounced  medicinal  aggravation.  We  may 
then  await  the  result,  and  hold  ourselves  in  readiness 
to  repeat  this,  or  whatever  other  medicine  may  be  ap 
propriate,  as  the  circumstances  of  the  case  may  re 
quire. 

Nux  vomica. — External  indications. — Face  bloated  ; 
eyelids  red,  weak,  and  watery  ;  stomach  distended ; 
tongue  tremulous,  red,  and  clean,  or  furred  with  a 
whitish  coat  in  the  centre  ;  offensive  breath  ;  frequent 
hiccough  ;  pulse  frequent,  small,  and  feeble. 

Physical  sensations. — Burning  pain  in  the  stomach, 
with  pulsations  and  spasmodic  contractions  in  the 
epigastric  region ;  nausea  and  vomiting,  aggravated 
after  eating  or  drinking ;  tenderness  arid  pain  in  the 
pit  of  the  stomach  when  pressed,  or  during  movement ; 
contraction  and  obstruction  in  the  oesophagus  when 
attempting  to  swallow ;  painful  sensation  of  distention 
of  the  stomach  ;  dizziness  and  confusion  of  the  head, 
on  rising  from  the  recumbent  position,  or  in  attempting 
to  walk  ;  sour  or  bitter  eructations. 
.  Mental  and  moral  symptoms. — Great  uneasiness  and 


256  DISEASES    OF    THE    ORGANS    AND    TISSUES 

anxiety ;  morose,  peevish,  sad,  and  often  disposition 
to  commit  suicide. 

Administration. — This  medicine  is  peculiarly  appro 
priate  in  those  cases  which  are  induced  by  abuse  of 
coffee,  wine,  spirits,  condiments,  and  stimulating  food. 
One  drop  of  the  sixth  dilution  to  an  ounce  of  water  ; 
a  tablespoonful  once  in  two  to  four  hours,  so  long  as 
the  symptoms  remain  stationary.  Occasionally  we 
shall  have  conjoined  with  the  above  symptoms,  cere 
bral  disorder,  indicated  by  delirium,  optical  illusions, 
and  great  derangement  of  the  nervous  system.  In 
such  instances  an  occasional  dose  of  belladonna  will 
prove  specific. 

Pulsatilla  is  a  valuable  remedy  when  the  inflam 
mation  is  brought  on  by  the  use  of  crude,  indigestible, 
and  irritating  food.  It  covers  the  following  symp 
toms  :  pressing  or  shooting  pains  in  the  stomach  ; 
pulsations  in  the  pit  of  the  stomach  ;  epigastrium 
sensitive,  and  painful  to  the  touch,  or  on  pressure  ; 
nausea  and  vomiting  after  eating  or  drinking; 
nausea  and  disagreeable  feeling,  extending  even  to 
the  oesophagus  and  throat ;  regurgitation  of  food ; 
eructations ;  hiccough  ;  painful  distention  of  the 
stomach  ;  pulse  quick  and  small ;  and  bitter  taste  in 
the  mouth. 

Aconite,  at  the  third  to  the  sixth  dilution,  will  do 
good  service  when  the  febrile  symptoms  run  high  ;  to 
be  repeated  often  until  amendment  ensues,  either 
alone  or  in  alternation  with  the  gastric  specifics,  as 
the  nature  of  the  case  demands. 

Iodine,  at  the  third  potency,  has  afforded  relief  in 
inflammations  of  the  stomach  caused  by  abuse  of  mer 
cury  and  other  irritating  drugs.  The  indications  for 
its  use  are,  frequent  nausea ;  vomitings,  especially 
after  eating ;  burning  pains  and  pulsations  in  the 
stomach,  pyrosis,  sour  eructations,  contraction  and 
burning  of  the  oesophagus  ;  pulse  frequent,  small  and 
hard.  Colchicum  is  an  important  remedy  in  cases  of 
metastases  of  rheumatism  to  the  stomach.  It  acts 
specifically  as  an  irritant  to  the  stomach,  even  when 
injected  into  the  veins. 

A  single  dose  of  ipecacuanha,  at  the  sixth  potency, 
will  sometimes  afford  prompt  relief  in  cases  where 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  257 

vomiting  is  violent  and  incessant.  It  is  applicable 
in  inflammation  caused  by  excessive  doses  of  tarlarized 
antimony,  corrosive  sublimate,  arsenic,  &c.,  for  the  pur 
pose  of  allaying  the  excessive  irritation  and  vomiting 
which  follow  poisonous  doses  of  these  articles. 

SECTION   V. 

CHRONIC       GASTRITIS. CHRONIC       INFLAMMATION      OF      THE 

STOMACH.  ^ 

Diagnosis. — Many  of  the  symptoms  of  this  malady 
are  similar  in  character  to  those  which  occur  in 
the  acute  form,  but  there  is  a  material  difference  in 
regard  to  their  grade  of  violence  in  the  two  diseases. 
Sometimes  chronic  gastritis  is  the  result  of  a  partially 
subdued  acute  attack,  which  from  various  causes  is 
kept  up  for  a  long  period  in  this  state  of  sub-acute  in 
flammation.  At  other  times  it  comes  on  slowly  and 
insidiously,  from  a  combination  of  causes  operating  at 
the  same  time.  Amongst  the  symptoms  which  usually 
attend  this  complaint,  may  be  enumerated  these  :— 
pain  and  tenderness  in  some  particular  part  of  the 
stomach,  excited  by  pressure,  or  by  certain  kinds  of 
food  and  drinks  ;  frequent  vomiting  of  food  and  drink 
soon  after  they  are  swallowed ;  loss  of  appetite,  pu 
trid  taste  in  the  mouth  ;  thirst ;  fetid  breath  ;  acid  or 
bitter  eructations  ;  acidity  ;  distention  of  the  stomach 
with  wind,  which  causes  distressing  vertigo,  and  pains 
in  the  epigastric  and  hypochondriac  region  ;  tongue 
red  and  clean,  or  furred  in  the  middle  with  a  dirty  fur  ; 
melancholy ;  peevishness  ;  irritability  ;  discourage 
ment  ;  and,  finally,  hectic  fever,  emaciation,  sudden 
prostration,  and  death. 

Causes. — The  most  powerful  predisposing  causes  of 
this  malady  are,  protracted  sufferings  under  the  de 
pressing  mental  emotions  and  the  habitual  use  of  irri 
tating  drugs.  It  often  succeeds  to  acute  gastritis 
which  has  been  but  partially  subdued  ;  it  may  also 
arise  from  high  living,  the  abuse  of  wine,  liquors, 
coffee,  &c.,  repelled  eruptions,  metastases  of  rheuma 
tism  and  gout,  injuries,  and  occasionally  as  a  conse 
quence  of  other  diseases  which  have  been  badly 
managed. 

Therapeutics. — The   medicines  to    which    we   have 


259  DISEASES    OF    THE    ORGANS    AND    TISSUES 

alluded  under  acute  gastritis,  will  be  the  most  appli-. 
cable  in  the  ordinary  forms  of  the  chronic  variety. 
The  following  medicines  will  likewise  cover  many 
symptoms  of  sub-acute  gastritis,  namely,  bismuthum, 
baryta  muriatis,  bryonia,  cuprum  met.,  digitalis  pur- 
purea,  hyoscyamus,  ignatia,  mercurius,  phosphorus, 
arnica. 

SECTION  VI. 

DYSPEPSIA. INDIGESTION. 

Diagnosis. — This  very  troublesome  malady,  regard 
ed  for  some  reason  as  one  of  the  banes  of  good  society, 
manifests  itself  under  so  many  different  aspects,  and 
is  so  entirely  irregular  in  its  causes,  modes  of  attack, 
progress,  violence,  and  duration,  that  there  is  a  wide 
difference  of  opinion  amongst  physicians  in  regard  to 
its  true  nature.  While  some  have  referred  it  to  a 
sub-acute  inflammation  of  the  mucous  coat  of  the  stom 
ach,  others  have  considered  it  as  in  the  liver,  the 
cardiac  nerves,  or  the  secretory  apparatus  of  the  stom 
ach.  The  nature  and  precise  location  of  dyspepsia 
have  been,  and  still  are,  to  a  considerable  extent,  in 
volved  in  obscurity,  and  it  is  a  consequence  of  this  that 
its  victims  have  received  so  little  sympathy  or  charity 
either  from  medical  men  or  from  non-professional  ob 
servers.  It  is  a  disease,  nevertheless,  which  in  its  dif 
ferent  phases  displays  symptoms  and  sufferings  almost 
innumerable,  as  is  proved  from  the  circumstance  of  its 
having  been  confounded  with  chronic  gastritis,  car- 
dialgia,  bilious  affections,  liver  complaint,  &c.  At  one 
time  the  patient  will  attribute  his  sufferings  to  his 
head,  and  entertain  the  most  alarming  apprehensions 
of  apoplexy ;  at  another,  to  his  respiratory  organs,  and 
imagine  he  has  consumption;  again,  he  describes  his 
malady  as  in  the  liver,  or  the  stomach,  or  the  bowels, 
or  the  spleen ;  and  thus  he  continues  on  from  month 
to  month,  or  from  year  to  year,  a  martyr  to  the  most 
distressing  chronic  affection  to  which  humanity  is  sub 
ject. 

Dyspepsia  may  make  its  appearance  in  a  gradual 
and  almost  imperceptible  manner,  or  it  may  supervene 
suddenly  in  a  severe  form  without  previous  warning. 
It  may  so  affect  the  system  as  to  remind  one  constantly 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  259 

of  its  existence,  or  its  symptoms  may  only  manifest 
themselves  after  the  use  of  certain  indigestible  articles 
of  food,  or  protracted  depression  of  spirits. 

Amongst  the  more  common  symptoms  of  this  com 
plaint  may  be  mentioned,  tenderness  and  distention 
of  the  epigastrium,  acidity,  flatulency,  eructations, 
sense  of  weight  and  fulness  in  the  stomach  after  eat 
ing  ;  also  quick  breathing,  sensitiveness  at  the  pit  of  the 
stomach  from  pressure,  tight  clothing,  &c.,  pyrosis, 
vertigo,  giddiness,  sensation  when  walking  as  if  the 
pavement  were  rising  up  immediately  in  front ;  consti 
pation,  pressure  in  the  stomach  and  epigastrium, 
haemorrhoids,  sallow  or  yellow  complexion,  distention 
of  the  abdomen  with  flatus,  loss  of  ambition  and 
energy,  sad,  desponding,  dread  and  apprehension  re 
specting  the  future,  frequent  inclination  to  commit 
suicide,  nights  restless  and  disturbed  by  unpleasant 
dreams.  In  the  advanced  stages  of  indigestion,  there 
often  supervenes  a  troublesome  cough,  attended  with 
occasional  pains  in  the  chest,  and  mucous  or  muco- 
purulent  expectoration,  which  some  writers  have 
termed  dyspeptic  phthisis.  It  is  probable,  in  these 
cases,  that  the  disease  is  confined  to  the  mucous  mem 
branes  of  the  respiratory  organs,  being  a  continuation 
or  extension  of  the  gastric  disturbance,  to  the  pulmo 
nary  mucous  tissues. 

The  character  of  the  gastric  sensations  is  so  diverse 
in  different  cases,  that  scarcely  a  pain  or  a  sensation 
can  be  described,  which  has  not  been  experienced  by 
the  dyspeptic.  It  is  often  conjoined  with  cardialgia, 
chronic  gastritis,  or  chronic  hepatitis,  and  therefore 
some  symptoms  of  either  of  these  diseases  may  be 
present  in  any  given  case. 

Our  own  opinion  is,  that  indigestion  is  not  attributa 
ble  solely  to  sub-acute  gastric  irritation,  or  disease  of 
the  cardiac  nerves,  or  of  the  intestinal  canal,  or  de 
rangement  of  the  gastric  secretion,  but  to  a  combina 
tion  of  all  these  maladies.  This  is  satisfactorily 
evinced  from  the  fact,  that  in  the  worst  forms  of  indi 
gestion,  many  of  the  principal  symptoms  of  each  of 
these  disorders  are  uniformly  present. 

Causes. — Protracted  depression  of  spirits,  whether 
occasioned  by  want  of  occupation,  deprivation  of  the 


260  DISEASES    OF    THE    ORGANS    AND    TISSUES 

accustomed  mental  and  physical  exercise,  pecuniary 
misfortune,  loss  of  friends,  disappointment,  or  mortifi 
cation,  is  a  prominent  cause  of  dyspepsia.  This  cause 
is  very  general  and  extended  in  its  operation,  affecting 
not  only  the  mucous  structure  of  the  stomach,  but  the 
liver,  the  bowels,  the  cardiac  nerves,  and  in  some  in 
stances  the  whole  nervous  system.  It  is  to  this  variety 
of  indigestion  that  should  be  attributed  many  of  those 
hypochondriacal  affections,  which  are  often  referred 
exclusively  to  disorder  of  the  liver. 

Next  in  importance  to  the  above,  may  be  named, 
the  abuse  of  rich  and  highly  seasoned  food,  stimula 
ting  drinks,  coffee,  tea,  tobacco,  irregular  eating  hours, 
and  inattention  to  the  daily  faecal  evacuations. 

When  chronic  gastritis  becomes  complicated  with 
cardialgia,  chronic  hepatitis,  &c.,  the  resulting  malady 
will  be  dyspepsia.  Another  common  cause  of  this 
complaint,  and  one  to  which  we  desire  to  direct  par 
ticular  attention,  is  the  habitual  use  of  cathartics. 
The  belief  has  so  long  and  so  generally  obtained,  that 
all  of  the  ills  of  the  organism  can  be  expelled  forcibly 
by  inflaming  and  raking  the  sensitive  and  delicate 
coats  of  the  stomach  and  bowels  with  cathartics,  that 
it  will  be  no  light  task  to  change  opinions  which  have 
become  (if  I  may  be  allowed  the  expression),  constitu 
tional.  If,  however,  the  intelligent  reader  will  remem 
ber  that  dyspepsia  consists  in  an  irritated  and  weak 
ened  state  of  the  nerves,  and  the  mucous  coat  of  the 
stomach,  together  with  disorder  of  the  liver,  he  cannot 
fail  to  perceive  that  the  effect  of  purgatives  must  be 
injurious  rather  than  beneficial.  We  are  quite  aware 
that  some  temporary  relief  is  occasionally  afforded  by 
cathartics,  but  innumerable  facts  warrant  the  asser 
tion  that  this  slight  alleviation  is  always  at  the  expense 
of  renewed  and  vastly  increased  future  suffering,  and 
that  each  new  dose  communicates  an  additional  im 
petus  to  the  advancement  of  the  disease  towards 
fatal  disorganization. 

Another  not  unfrequent  cause  of  indigestion,  is  re 
pelled  cutaneous  diseases,  like  erysipelas,  &c.  I  have 
met  with  a  number  of  well-marked  cases  of  this  de 
scription,  in  which  alleviation  of  all  the  symptoms  uni 
formly  occurred  when  the  eruption  was  upon  the  sur 
face. 


CONNECTED    WITH    THE    DI6ESTIVE    SYSTEM.  261 

Therapeutics. — An  essential  condition  in  the  treat 
ment  of  dyspepsia  is  the  maintenance  on  the  part  of 
the  patient,  of  a  healthy,  active,  and  cheerful  state  of 
mind.  Unless  this  be  accomplished,  our  remedies  will 
either  be  of  only  temporary  service,  or  entirely  un 
availing.  Next  in  importance,  is  a  course  of  rigid 
dietetic  regulations.  In  proposing  a  bill  of  fare  for  the 
dyspeptic,  much  must  depend  upon  the  circumstances 
of  each  particular  case.  If  the  patient  is  of  a  highly 
bilious  temperament,  a  much  more  simple  diet  will  be 
requisite,  than  for  one  who  is  nervous  or  sanguine. 
As  a  general  rule,  an  intelligent  person  will  be  able 
to  select  a  suitable  diet  for  himself,  by  observing  at 
tentively  the  effects  which  different  articles  exert  upon 
his  constitution. 

Another  equally  important  condition  in  the  treat 
ment  of  this  complaint,  is  perfect  regularity  in  all  the 
habits  of  life,  as  eating,  sleeping,  alvine  evacuations, 
exercise,  &c.  First,  sufficient  sleep  should  be  allowed, 
to  enable  the  system  to  recover  entirely  from  the  fa 
tigues  of  the  preceding  day;  second,  moderate  and  agree 
able  exercise  should  be  taken  for  an  hour  or  so,  pre 
vious  to  breakfast,  bearing  in  mind  that  exercise,  in 
order  to  be  beneficial,  must  not  be  undertaken  and  per 
formed  as  a  task,  but  as  a  pleasant  recreation  ;  third, 
in  partaking  of  our  food,  we  should  never  forget,  while 
we  are  thus  repairing  the  waste  of  the  body,  from  the 
exercise  of  the  functions,  &c.,  that  this  also  was  in 
tended  by  our  Creator  to  be  a  source  of  pleasure  to 
us.  Let  the  rational  man,  therefore,  and  especially 
the  dyspeptic,  never  eat  with  disordered  rapidity,  but 
slowly,  so  that,  masticated  properly,  his  food  may  be 
taken  into  the  stomach  in  a  fit  condition  for  the  pro 
cesses  of  digestion.  This  is  the  true  philosophy  of  eat 
ing.  Finally,  at  a  certain  hour  every  day,  perhaps  after 
breakfast,  an  evacuation  from  the  bowels  should  be 
solicited.  It  matters  not  whether  the  inclination  be 
uniformly  present,  let  the  patient  never  fail  in  his 
readiness,  and  the  bowels  will  soon  form  the  habit  of 
responding.  So  much  are  we  the  creatures  of  habit, 
that  we  can  train  our  bodies,  our  organs,  our  appe 
tites,  tastes,  &c.,  to  almost  anything  we  desire,  by  a 
steady  persistence  in  our  object. 


262  DISEASES    OF    THE    ORGANS    AND    TISSUES 

The  most  approved  remedies  for  the  different  grades 
of  indigestion,  are,  nux,  sulph.,puls.,  bry.,  lycopod.,  calc. 
carb.,  sepia,  graph.,  ignat. 

Nux  vomica  is  well  adapted  to  the  cases  which  oc 
cur  in  sanguine  or  bilious  temperaments,  and  which 
have  been  induced  by  "  high  living,"  sedentary  habits, 
undue  mental  exertion,  irregularity  in  eating,  sleeping, 
&c.  The  external  indications  for  nux,  are,  florid  or 
pale,  sallow  or  yellow  complexion  ;  general  expression 
of  countenance,  anxious  and  sad,  care-worn  ;  tongue 
dry,  or  covered  with  a  whitish  coat ;  occasional  ful 
ness  in  the  region  of  the  stomach  and  bowels. 

Physical  sensations. — Distress  at  the  stomach  after 
eating  ;  nausea  and  vomiting  of  food ;  eructations  ; 
pyrosis  ;  distressing  sense  of  debility  ;  irritability  of 
the  nervous  system,  with  constant  inclination  to  roam 
about ;  symptoms  worse  after  meals,  and  in  the  even 
ing  ;  constipation  ;  haemorrhoids ;  tenderness  at  the 
pit  of  the  stomach  on  pressure  ;  vertigo,  dizziness,  or 
swimming  in  the  head,  particularly  when  rising  in  the 
morning,  or  on  walking  about  ;  cramp-like  pains  at 
the  pit  of  the  stomach,  sometimes  extending  upwards 
to  the  diaphragm  and  oesophagus. 

Mental  and  moral  symptoms. — Confirmed  hypochon 
dria  ;  constant  dread  of  approaching  misfortune  ;  in 
clination  to  look  upon  the  dark  side  of  everything  ; 
trifles  exaggerated  into  matters  of  importance  ;  urgent 
inclination,  at  times,  to  commit  suicide ;  excessive  ner 
vous  irritability. 

When  dyspepsia  consists  simply  of  impaired  activity 
of  the  nerves  of  the  stomach,  from  the  causes  just 
named,  nux  is  without  doubt  the  appropriate  specific  ; 
but  it  is  an  almost  invariable  occurrence,  that  this  con 
dition  of  the  stomach  is  attended  with  more  or  less  de 
rangement  of  the  nervous  system,  manifested  by  loss 
of  animation  and  energy ;  depression  of  spirits  ;  an  in 
vincible  tendency  to  look  on  the  dark  side  of  affairs, 
and  an  indefinable  sense  of  dissatisfaction,  dread,  and 
uneasiness,  which  impairs  the  appetite,  disturbs  the 
sleep,  and  almost  unfits  the  individual  for  the  ordinary 
duties  of  life.  When  this  condition  of  the  nervous  sys 
tem  has  existed  for  a  considerable  time,  it  receives  the 
name  of  hypochondria.  For  this  complication,  nux 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  263 

alone  is  insufficient,  but  one  or  more  of  the  medicines 
hereafter  ennumerated,  will  be  required. 

Administration. — In  cases  of  this  description,  we  usu 
ally  prescribe  nux  vomica  from  the  third  to  the  sixth 
potency ;  a  dose  to  be  given  each  night,  as  long  as 
may  be  necessary. 

Sulphur  is  peculiarly  adapted  to  the  treatment  of 
cases  occurring  in  persons  of  a  scrofulous  dyscrasia, 
and  to  cases  which  appear  to  be  connected  with  ery- 
sipelatous  and  other  eruptive  affections.  Dyspeptic 
symptoms  occasionally  supervene  upon  the  disappear 
ance  of  erysipelatous  and  other  eruptions  from  the  sur 
face,  also  from  the  sudden  suppression  of  long  continu 
ed  haemorrhoidal  discharges.  In  many  cases  of  this 
kind,  sulphur  will  be  found  a  valuable  remedy. 

The  external  marks  wich  indicate  this  medicine,  are, 
pale  or  sallow  countenance;  light  hair;  blue  eyes; 
thin  skin ;  white  teeth  ;  glandular  swellings ;  erup 
tions  ;  weak  eyes,  and  the  other  signs  of  scrofulous  dia 
thesis. 

Physical  sensations. — Distention  and  distress  of  the 
stomach  after  eating  ;  nausea  ;  vomiting  ;  pyrosis  ; 
frequent  eructations,  acid  or  bitter  ;  the  symptoms  oc 
curring,  for  the  most  part,  on  the  disappearance  of  some 
eruption  or  accustomed  discharge,  and  going  off  onfhe 
reappearance  of  these  eruptions  or  discharges. 

Mental  and  moral  symptoms. — Sadness  ;  irritability  ; 
moroseness. 

Administration. — This  medicine  may  be  administer 
ed  at  the  third  attenuation,  in  the  morning  and  mid 
dle  of  the  afternoon. 

Pulsatilla,  at  the  third  potency,isa  valuable  remedy 
in  dyspepsia  occurring  in  females,  especially  when  the 
malady  is  complicated  with  deranged  menstruation. 
If  the  disorder  has  arisen  from  excessive  use  of  greasy 
and  indigestible  food,  wine,  &c.,  it  will  also  prove  a 
suitable  remedy. 

Bryonia,  at  the  third  attenuation,  is  well  adapted  to 
persons  of  a  bilious  temperament,  with  black  hair, 
dark  complexions,  and  black  eyes.  The  particular  in 
dications  for  its  employment,  are,  yellowness  of  the 
skin  and  eyes ;  tongue  covered  with  a  yellowish  fur  ; 
bitter  taste ;  vomiting  or  regurgitation  of  food  soon 


264  DISEASES    OF    THE    ORGANS    AND    TISSUES 

after  eating ;  sensation  of  fulness  and  burning  in  the 
stomach  after  meals  ;  fulness  and  pains  in  the  region 
of  the  liver ;  urine  high-coloured  ;  head  confused  and 
giddy  ;  pressure  in  the  head  ;  loss  of  memory  ;  inabil 
ity  to  transact  business  ;  great  despondency  ;  frequent 
inclination  to  commit  suicide  ;  constant  sighing  ;  sleep 
less  nights,  or  sleep  disturbed  by  unpleasant  dreams. 

Lycopodium,  calcarea  carb.,  and  sepia,  may  be  given 
in  mild  cases  of  indigestion,  occurring  in  weakly  fe 
males  and  children,  and  persons  of  a  lymphatic  or 
scrofulous  constitution.  It  may  be  exhibited  at  the 
third  attenuation — a  dose  each  day  as  long  as  may  be 
necessary.  In  cases  where  the  above  remedies  are  in 
dicated,  a  highly  nutritious  regimen  may  be  enjoined 
with  great  advantage,  also  the  constant  employment 
of  all  those  means  which  tend  to  invigorate  the  sys 
tem,  like  active  exercise,  sea  air,  and  bathing ;  fre 
quent  amusement  for  mind  and  body,  &c. 

Graphite  is  valuable  in  dyspeptic  symptoms  which 
appear  to  be  connected  with  scrofulous  or  arthritic  af 
fections.  It  will  be  found  particularly  serviceable 
when  they  supervene  upon  the  sudden  disappearance 
of  eruptions  from  the  skin,  or  the  sudden  suppression 
of  old  discharges,  or  the  drying  up  of  old  sores. 

Administration. — Same  as  lycopodium. 

Ignatia. — We  have  witnessed  much  benefit  from  the 
use  of  this  medicine  in  indigestion  afflicting  persons  of 
a  nervous  temperament.  It  covers  the  following 
symptoms,  viz  :  countenance  pale  or  sallow  ;  eyes  con 
stantly  in  motion  ;  general  expression  indicative  of 
anguish  and  despair ;  frequent  sighing ;  constant  in 
clination  to  move  about  ;  confusion  of  ideas ;  loss  of 
memory  ;  pressure  and  other  bad  feelings  in  the  head  ; 
distress  at  the  stomach  after  eating  ;  appetite  variable  ; 
tongue  covered  with  a  thin  white  fur ;  entire  despair 
of  recovery  ;  feels  as  if  getting  worse  every  day ;  dread 
of  misfortune,  coming  want,  &c. :  frequent  inclination 
to  commit  suicide ;  disinclination  to  see  or  converse 
with  friends  or  acquaintances  ;  seeks  solitude,  and 
broods  over  imaginary  troubles. 

This  medicine  may  be  given  at  the  third  attenua 
tion,  a  drop  once  in  twelve  hours,  until  an  impression  is 
made  upon  the  malady. 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  865 

In  cases  where  the  nervous  system  is  so  much  in 
volved  that  the  patient  desires  to  die,  and  continually 
contemplates  suicide,  rather  than  suffer  longer  from 
his  morbid  and  unfounded  imaginings,  and  the  wretch 
edness  and  anguish  which  tortures  him  day  and  night, 
aurum  muriate,  at  the  first  or  second  trituration,  will  be 
found  a  remedy  of  the  utmost  importance.  One  grain 
may  be  given  twice  daily  until  an  amendment  occurs. 

The  occasional  use  of  mild  aperients  in  certain 
cases  of  dyspepsia,  as  well  as  in  convulsions,  diar 
rhoea,  <fcc.,  caused  by  the  presence  of  indigestible  food 
in  the  stomach  and  bowels,  may  be  advisable  for  the 
same  reason  that  paracentesis  is  recommended  in  ur 
gent  cases  of  abdominal  or  thoracic  dropsy.  By 
evacuating  the  unnatural  accumulations,  we  not 
only  place  the  disordered  parts  in  a  more  favourable 
condition  to  recover  their  lost  energy,  but  we  also 
secure  a  much  better  state  of  things  for  the  operation 
of  our  remedies.  In  obstinate  constipation,  for  ex 
ample,  the  indurated  and  impacted  fecal  matter  some 
times  induces  so  great  an  inactivity  of  the  muscular 
and  nervous  structure  of  the  intestinal  canal,  as  to 
amount  almost  to  paralysis.  In  these  cases,  both  high 
and  low  attenuations  now  and  then  prove  inefficient ; 
and  it  is  here  that  mild  aperients  and  injections  will 
sometimes  prove  serviceable,  not,  however  as  curative 
agents,  but  by  speedily  removing  a  cause  of  disease, 
and  thus  placing  the  affected  parts  in  the  best  possible 
condition  to  ensure  the  proper  action  of  a  homoeopathic 
medicine. 

The  observations  of  Dr.  Madden,  of  Brighton,  are  so 
just  respecting  this  subject,  and  so  much  to  the  point, 
that  we  take  pleasure  in  quoting  them  in  this  connec* 
tion.  "But  it  not  unfrequently  happens,  that  the  be 
nefit  gained  by  an  immediate  unloading  of  the  bowels 
more  than  compensates  for  the  subsequent  increased 
tendency  to  constipation.  This  is  acknowledged  by 
all  in  the  case  of  poisoning.  No  homoeopathist  hesi^ 
tates  to  give  emetics  and  purges  when  a  person  has 
swallowed  a  substance  which,  if  not  speedily  re 
moved,  will  cause  death  ;  but  does  not  the  same  hold 
good  with  an  indigestible  meal  ?  It  is  no  doubt  true 
that  our  remedies  are  often  sufficient  of  themselves  to 

12 


266  DISEASES    OF   THE    ORGANS    AND    TISSUES' 

overcome  the  evil  influence  of  are  occasional  excess  at 
table  ?  yet  I  am  convinced  that  it  not  infrequently 
happens,  especially  in  childhood,  th-at  a  judicious 
aperient  would  at  once  remove  a  state  of  things 
which,  if  treated  otherwise,  would  entail  an  illness- 
requiring  several  days  to  overcome.  There  is  much 
unreasonable  prejudice  among  homeopathic  practi 
tioners  on  this  point ;  they  will  unhesitatingly  con 
demn  the  use  of  the  mildest  medicinal  aperient,  and 
yet  will  order  their  patients  to- eat  prunes,  figs,  roasted 
apples,  green  vegetables,  brown  bread,  &c^  in  the 
hopes  of  producing  the  same  result,  But  where  is 
the  difference  ?  A  dose  of  castor  oil,  far  example, 
produces  an  increased  action  of  the  bowels,  in  virtue 
of  its  being  an  indigestible  oil,  which  passes  through 
the  whole  intestinal  tube  unchanged,  and  perhaps- 
exerting  some  slight  irritating  effect  on  the  mucous 
membrane  ;  whereas  the  aliments  above  named  pro 
duce  the  same  results,  in  virtue  of  their  having  either 
a  large  indigestible  residuum  which  irritates  by  itsr 
presence,  or  by  their  containing  vegetable  acids,  which 
directly  and  specifically  irritate  the  mucous^  memv 
brane.  The  result,  therefore,  is  similar  in  both  eases.'r 
— British  Jour,  of  Horn.  No.  xxix,  p.  311. 

In  conclusion,  we  deem  it  proper  to  observe,  that 
aperients  should  never  be  employed  except  in  very 
urgent  cases,  or  in  those  where  our  attenuations  have 
failed  of  producing  the  required  effect.  In  all  in 
stances  it  is  to  be  looked  upon  as  a  mere  temporary 
expedient. 

SECTION  VII, 

H^EMATEMESIS. — VOMITING    OF    BLOOD. 

Diagnosis. — Previous  to  the  vomiting  there  is  ex 
perienced  a  sense  of  weight,  fulness,  pressure,  and 
disturbance  in  the  stomach,  nausea,  faintness,  debility r 
general  uneasiness,  giddiness  and  confusion  in  the 
head,,  roaring  in  the  earsy  anxiety,  bitter  or  saltish 
taste  in  the  mouth,  loss  of  appetite,  occasional  chills, 
and  sometimes  pains  in  the  stomach,  side,  or  chest. 
The  pulse  is  for  the  most  part  small  and  contracted, 
though  now  and  then  full  and  bounding, 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  267 

**  The  haemorrhage  no  doubt  generally  occurs  from 
the  mucous  membrane  of  the  stomach,  but  it  is 
thought  also  to  proceed  in  some  cases  from  the  liver 
or  spleen.  When  the  blood  comes  from  the  former 
organ,  it  passes  along  the  common  bile  duct  into 
the  duodenum,  and  thence  regurgitates  into  the  stom 
ach.  When  the  spleen  is  the  source  of  the  haemor 
rhage,  if  this  be  ever  the  case,  the  blood,  it  is  sup 
posed,  gains  admission  into  the  stomach  through  the 
vassa  brevia." — (Dewees). 

The  appearance  of  the  blood  which  is  thrown  up 
varies,  being  in  some  instances  liquid  and  bright  red, 
at  other  times  black,  or  coagulated.  If  the  haemor 
rhage  proceeds  directly  from  the  rupture  of  a  blood 
vessel  in  the  stomach,  it  will  be  red  and  liquid  ;  but 
if  it  has  been  conveyed  from  the  liver  or  spleen  into 
this  organ,  it  will  be  black  and  perhaps  coagulated. 

The  quantity  of  blood  which  is  sometimes  vomited 
from  the  stomach  is  very  great.  I  have  in  several  in 
stances  witnessed  the  loss  of  two,  three,  and  even  four 
quarts  from  this  organ  without  any  very  serious  in 
convenience,  and  that  too  in  persons  whose  constitu 
tions  had  been  impaired  from  long-continued  intempe 
rance.  A  not  uncommon  result  of  these  profuse 
evacuations  is,  however,  the  supervention  of  dropsy, 
and  I  am  able  to  call  to  mind  two  instances  of  this 
description. 

Causes. — Intemperance,  suppression  of  accustomed 
discharges,  as  haemorrhoids,  catamenia,  &c.  :  conges 
tions  and  engorgements  of  the.  liver,  spleen  and  pan 
creas,  schirrous  and  other  ulcerations  of  the  gastro- 
mucous  membrane,  violent  inflammations,  whether 
caused  by  active  drugs  or  mechanical  injuries. 

Therapeutics.  —  The  principal  medicines  for  the 
treatment  of  this  malady  are,  aconite,  nux  vomica, 
pulsatilla,  ipecacuanha,  arnica,  veratrum,  arsenicum. 

SECTION    VIII. 

CARUALGIA. OASTRALGIA. 

Cardalgia,  as  we  have  seen,  is  usually  a  symptom 
of  dyspepsia,  although  writers  have  classed  it  as  a 
distinct  malady,  having  no  necessary  connection  with 


268  DISEASES    OF    THE    ORGANS    AND    TISSUES 

this  disorder.  The  intimate  relation  between  the 
nerves  and  membranes  of  the  stomach  and  the  liver, 
and  those  which  their  functions  sustain  towards  each 
other,  incline  us  to  the  opinion  that  derangements  of 
either  of  these  parts  of  the  organism  must  involve,  to 
a  greater  or  lesser  extent,  each  of  the  others.  The 
seat  of  cardalgia  is  in  the  nerves  of  the  stomach, 
and  as  the  healthy  tone  of  the  mucous  membrane, 
&c.,  is  dependent  upon  the  normal  integrity  of  the 
nerves  which  supply  this  organ,  their  mutual  depend 
ence  will  be  readily  perceived. 

Diagnosis.  —  Pinching,  gnawing,  and  cramp-like 
pains  in  the  stomach,  often  extending  into  the  back 
and  loins,  relieved  on  pressure  at  the  epigastrium,  or 
when  the  abdominal  muscles  are  relaxed,  faintness, 
anxiety,  appetite  natural,  or  but  slightly  impaired, 
pulse  natural ;  food  may  be  taken  into  the  stomach 
with  impunity  ;  pains  of  a  more  severe  character  than 
those  which  occur  in  chronic  gastritis,  although  there 
is  no  feeling  of  heat  or  thirst, 

Causes. — Highly  seasoned  or  crude  and  indigestible 
food,  abuse  of  stimulants,  coffee  and  tobacco,  irregu 
larity  in  eating,  and  the  use  of  narcotic  and  other 
drugs. 

Therapeutics. — The  following  medicines  will  cover 
all  symptoms  which  may  be  present  in  any  case  of 
cardalgia,  viz.,  nux  vomica,  pulsatilla,  acid  hydrocy 
anic,  carbo  veg.,  chamomela,  cocculus.  argentum,  sul 
phur,  causticum,  and  bryonia.  For  the  treatment  of 
other  symptoms  with  which  the  disease  may  be  com 
plicated,  the  reader  is  referred  to  the  chapter  on  dys 
pepsia. 

Administration. — The  remedies  may  be  exhibited 
from  the  third  to  the  sixth  potency,  and  at  intervals  of 
six  to  twelve  hours,  until  the  desired  effect  is  pro 
duced. 

SECTION  IX. 

ENTERITIS. 

Under  this  head  we  shall  proceed  to  describe  two 
varieties  of  intestinal  inflammation,  the  peritoneal  and 
muscular,  and  that  of  the  mucous  membrane.  The 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  '^69 

older  writers  have  confounded  peritoneal  enteritis 
with  ordinary  acute  peritonitis,  but  the  researches  of 
modern  pathologists  have  pointed  out  the  true  location 
and  nature  of  these  different  maladies. 

PERITONEAL    ENTERITIS, 

Diagnosis. — Lassitude,  rigours,  chills,  acute  pain  in 
some  part  of  the  abdomen,  swelling  and  exceeding  ten 
derness  in  the  affected  part,  nausea,  vomiting,  obsti 
nate  and  persistent  constipation,  urgent  thirst,  bitter 
taste,  loss  of  appetite,  parched  mouth,  hot  skin,  inspi 
rations  short  and  painful,  position  on  the  back  with 
knees  drawn  up,  and  inclination  to  preserve  the  re 
cumbent  posture,  pulse  frequent,  tense,  contracted, 
and  irregular,  urine  scanty  and  high  coloured. 

The  above  symptoms  will  be  modified  according  to 
the  particular  location  of  the  inflammation.  If  the 
small  intestines  are  the  principal  seat  of  the  disorder, 
symptoms  will  obtain  which  simulate  gastritis:  if  the 
colon  be  the  part  affected,  we  may  expect  symptoms 
resembling  hepatitis  to  be  present.  This  form  of  en 
teritis  is  violent  and  rapid  in  its  course,  and  according 
to  most  writers  is  "  peculiarly  prone  to  terminate  in 
gangrene.  When  this  termination  is  about  taking 
place,  the  pain  suddenly  subsides,  the  pulse  sinks  rap 
idly,  the  countenance  becomes  pale  and  cadaverous, 
the  extremities  cold,  the  surface  covered  with  a  cold 
clammy  sweat,  and  hiccough,  slight  delirium,  and  oc 
casionally  convulsions,  close  the  scene.  This  affec 
tion  is  seldom  protracted  beyond  the  seventh  or  eighth 
day,  without  terminating  either  in  resolution  or  in 
death."— Eberle. 

Causes. — The  employment  of  irritating  cathartics, 
like  calomel,  jalap,  croton  oil,  aloes,  scarnmony,  colo- 
cynth,  colchicum,  gamboge,  &c.,  poisons,  alcoholic 
liquors,  sudden  suppression  of  accustomed  discharges, 
repelled  eruptions,  worms,  external  injuries,  persistent 
constipation,  atmospheric  changes. 

Therapeutics. — Arsenicum,  veratrum,  aloes,  aconite, 
nux  vom.,  lycopodium,  opium,  ipecacuanha,  sulphur, 
plumbum,  rhus  tox.,  ac.  cuprum. 

Administration. — The  principal  remedies  in  the 
treatment  of  thismaladv,  are  arsenicum  and  veratrum. 


270  DISEASES    OP    THE    ORGANS    AND    TISSUES. 

They  may  be  exhibited  at  the  third  potency,  at  inter 
vals  of  one  to  four  hours,  according  to  the  severity  of 
the  symptoms.  Should  vomiting  be  very  violent  and 
persistent,  after  the  proper  administration  of  arsenicum 
or  veratrum,  recourse  should  be  had  to  ipecac.,  third 
attenuation.  When  the  inflammation  attacks  the 
large  intestines,  aloes  and  plumbum  may  be  given  in 
some  cases,  at  the  third  dilution,  after  veratrum  and 
arsenicum.  If  the  disorder  has  arisen  from  repelled 
eruptions,  or  metastasis  of  rheumatism,  gout,  erysipe 
las,  &c.,  we  may  resort  to  sulphur,  rhus,  or  ac.  cuprum, 
as  circumstances  require.  During  the  course  of  the 
disease,  aconite  will  occasionally  be  found  useful  in 
controlling  the  action  of  the  heart  and  arteries.  It- 
may  be  given  at  the  second  potency,  either  alone  or 
in  alternation  with  arsenicum  or  veratrum,  according 
to  the  symptoms. 

Auxiliary  to  the  above  remedies,  the  employment 
of  fomentations,  either  of  warm  or  cold  water,  as  the 
case  may  demand,  will  prove  of  eminent  service. 
Cloths  should  be  wrung  out,  and  applied  over  the  af 
fected  part,  (care  being  taken  to  protect  the  body  linen 
and  bed-clothes,)  renewing  them  once  in  fifteen  or 
twenty  minutes,  when  the  inflammation  and  pain  are 
severe. 

SECTION  X. 

ACUTE    MUCOUS    ENTERITIS. DYSENTERY. 

Diagnosis. — This  disease  sometimes  commences  with 
griping  pains  in  the  bowels,  with  frequent  discharges  of 
mucus  or  mucus  mixed  with  blood,  attended  during  the 
evacuations  with  more  or  less  straining  and  burning 
pain.  After  the  first  two  or  three  evacuations,  nothing 
but  mucus,  or  mucus  and  blood,  are  passed.  Occa 
sionally  the  griping  and  diarrhoea  are  preceded  by 
lassitude,  chills,  weakness  and  pains  in  the  limbs, 
thirst,  bad  taste  in  the  mouth,  furred  tongue,  hot  and 
dry  skin,  frequent  and  hard  pulse,  anxiety,  and  general 
restlessness.  The  disease  is  peculiarly  apt  to  be 
ushered  in  with  these  last-named  symptoms,  when  it 
has  been  caused  by  sudden  suppression  of  perspiration, 
atmospheric  vicissitudes,  or  miasmatic  influences. 


WITH    THE    DIGESTIVE    SYSTEM.  271 

The  appearance  of  the  fluids  discharged,  will  depend 
anuch  upon  the  climate,  temperament,  the  exciting 
cause,  and  the  particular  portion  *of  the  intestinal 
<;anal  affected.  If  the  small  intestines  are  chiefly  dis 
ordered,  the  evacuations  will  consist  of  dark  watery 
matter,  mixed  with  mucus  and  blood,  while  inflamma 
tion  of  the  colon  and  rectum  will  give  rise  to  dis 
charges  of  pure  mucus  and  blood,  preceded  and  attend 
ed  with  distressing  tormina,  and  inclination  to  remain 
<a  good  part  of  the  time  &t  stool.  These  discharges, 
which  are  highly  offensive,  afford  some  temporary  re 
lief  te  the  patient,  only  to  be  renewed  with  increased 
severity.  There  are  tenderness  of  the  bowels  on  pres 
sure,  pain  and  burning  in  making  water,  inclination 
to  lie  upon  the  back,  with  the  knees  drawn  up,  great 
depression  of  spirits,  short  and  painful  inspirations, 
universal  heat  and  dryness  of  the  skin,  more  or  less 
derangement  in  the  function  of  the  liver,  indicated  by 
an  icterode  hue  of  the  skin,  and  the  absence  of  bile  in 
the  evacuations,  rapid  emaciation,  loss  of  strength, 
and  increasing  disinclination  to  physical  effort.  As 
the  disease  advances  towards  a  fatal  termination,  the 
countenance  assumes  a  contracted  and  cadaverous  ex 
pression,  the  pulse  sinks,  the  evacuations  become  more 
foetid,  and  are  discharged  involuntarily,  the  pains 
abate  or  cease  entirely,  a  cold  sweat  occurs,  hiccough, 
delirium,  cramps,  and  extreme  prostration  obtain, 
and  then  death, 

Causes. — Atmospheric  vicissitudes,  deranged  func 
tion  of  the  liver,  abrupt  checks  to  perspiration, 
"koino  miasmata  have  frequently  an  unequivocal 
agency  in  the  production  of  this  disease,"  (Eberle), — the 
irritation  of  teething,  worms,  and  drastic  drugs,  crude 
vegetables  and  unripe  or  decayed  fruits. 

Prognosis. — The  prognosis  of  dysentery  will  vary 
according  to  the  climate,  the  location,  the  season  of 
year,  the  constitution  of  the  patient,  and  its  compli 
cations  with  typhus,  cholera,  or  other  contagious  mal 
adies. 

Hot  and  damp  regions,  abounding  in  luxuriant  veg 
etation  which  is  constantly  undergoing  decomposition, 
and  filling  the  air  with  miasmatic  particles,  predispose 
the  system  to  dysenteric  aifections,  and  serve  to  ren- 


272  DISEASES    OP    THE    ©RGANS    AND    TISSUES 

der  them  violent  and  dangerous.  Low,  marshy,  and 
damp  situations  favour  the  formation  of  the  disease, 
more  than  eleva&d  and  dry  locations.  It  is  far  more 
common,  severe,  and  fatal  in  the  months  of  July  and 
August,  in  this  country,  than  at  any  other  period  of  the 
year ;  and  it  is  rare  that  individuals  who  are  strongly 
predisposed  to  it,  entirely  escape  during  these  months. 
When  it  is  succeeded  or  accompanied  with  typhoid 
symptoms,  or  when  it  occurs  as  a  symptom  of  typhus 
fever,  it  may  be  looked  on  as  a  malady  of  the  most  dan 
gerous  character,  and  one  which  will  require  the  most 
judiciously  directed  resources  of  our  art.  In  these  in 
stances  we  have  to  combat,  not  only  the  local  intesti 
nal  disorder,  but  also  constitutional  symptoms  of  the 
greatest  severity.  During  the  prevalence  of  Asiatic 
cholera,  dysentery  has  been  observed  to  assume  a  more 
malignant  form  than  in  those  years  when  this  destruc 
tive  epidemic  has  not  prevailed.  While  the  cholera 
was  destroying  its  thousands  weekly  in  our  large 
cities,  during  the  last  summer,  a  malignant  dysentery 
prevailed  in  most  of  the  smaller  cities  and  towns, 
sweeping  off  numbers  entirely  unprecedented.  In 
these  last  examples,  the  epidemic  influence  was  not 
sufficiently  active  to  generate  the  actual  cholera 
asphyxia,  but  it  conduced  to  aggravate  very  mate 
rially,  the  type  of  dysentery. 

Therapeutics. — Mercurius,  arsenicum,  chamomela,pul- 
satilla,  colocynlh,  aconite,  ipecacuanha,  nux  vomica, 
carlo  veg.,  sulphur,  dulcamara,  aloes,  acid  nit.,  acid  mur. 

Mercurius  corrosive. — External  indications. — Anx 
ious  expression  of  countenance  ;  features  distorted  by 
pain  ;  knees  drawn  up ;  head  and  shoulders  elevated, 
or  bent  forward  ;  fulness  of  the  abdomen  ;  skin  hot  and 
dry  ;  tongue  dry  and  dirty  ;  pulse  frequent  and  tense  ; 
inspirations  short  and  imperfect,  and  effected  princi 
pally  with  the  muscles  of  the  chest ;  evacuations  of 
pure  blood,  or  mucus  mixed  with  blood,  or  dark  and 
bilious  and  foetid. 

Physical  sensations. — Sharp,  cutting  pains  in  the 
bowels,  accompanied  with  very  frequent  and  urgent 
desire  to  go  to  stool,  and  tenesmus  ;  desire  to  remain 
long  at  stool ;  abdomen  excessively  painful  on  pressure, 
with  constant  sensation  of  distention ;  dryness  of  the 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  273 

mouth  and  throat,  with  intense  thirst ;  involuntary 
tvvitchings  of  the  muscles  on  going  to  sleep  ;  pain  at 
the  neck  of  the  bladder  in  urinating ;  cheeks  and 
abdomen  hot  and  flushed,  while  the  extremities  are 
cold  ;  drawings,  pinchings,  or  cramps  in  the  limbs, 
often  deep  seated ;  pains  increased  at  each  inspi 
ration  ;  shivering  on  the  least  exposure  ;  aggravation 
of  the  symptoms  at  night ;  sense  of  pain  and  fatigue 
in  the  joints. 

Mental  and  moral  symptoms. — Out  of  humour ;  irri 
table  ;  petulant ;  desponding  ;  reckless. 

Administration. — One  grain  of  the  third  trituration 
may  be  given  every  hour  until  the  violence  of  the  dis 
ease  is  subdued,  when  the  intervals  may  be  lengthened, 
or  the  medicine  suspended,  according  to  the  exigencies 
of  the  case.  Some  writers  advise,  an  alternation  of 
this  remedy  with  colocynth,  where  the  indications 
point  to  the  latter  as  well  as  the  former  medicine. 
We  have  occasionally  prescribed  these  articles  in 
alternation  with  unequivocal  benefit. 

Mercurius  sol. — This  form  of  mercury  is  more  par 
ticularly  adapted  to  the  treatment  of  those  cases 
which  are  principally  located  in  the  upper  portion  of 
the  intestinal  canal,  the  external  indications  for  which 
are,  yellowish  colour  of  the  skin  ;  offensive  breath  ; 
tongue  covered  with  a  white,  thick,  tenacious  mucus  ; 
distention  in  the  superior  part  of  the  abdomen  ;  eva 
cuations  of  foetid  mucus  and  bilious  matter,  of  a  green 
or  darkish  colour,  or  of  bloody  mucus;  prolapsus  of 
the  rectum,  which  is  red  and  inflamed  ;  urine  of  a 
deep  red  or  brown  colour  and  offensive  ;  position, 
respiration,  pulse,  temperature,  thirst,  &c.,  same  as 
under  mere.  cor. 

Physical  sensations. — Violent  cutting  pains  in  the 
abdomen,  accompanied  by  shivering,  during  and  after 
the  evacuations  ;  great  tenderness  on  pressure,  in  the 
region  of  the  small  intestines ;  frequent  desire  to 
evacuate  the  bowels,  accompanied  by  violent  tenes* 
mus  ;  discharges  small  in  quantity  ;  aggravation  of 
pains  at  night ;  frequent  and  urgent  desire  to  urinate  ; 
nausea  and  vomiting,  with  pain  in  the  stomach  ;  thirst 
for  cold  drinks ;  cramps  and  contractions  in  the 
umbilical  region ;  weakness  and  rapid  sinking  of 


274  DISEASES    OF    THE    ORGANS    AND    TISSUES 

strength  ;  painful  sense  of  distention  in  the  abdomen  ; 
sense  of  fatigue  and  great  weakness  in  the  limbs. 

Mental  and  moral  symptoms. — Morose  ;  irritable  ; 
great  anguish  and  discouragement ;  peevish  ;  quarrel 
some. 

Administration. — Same  as  mere.  cor. 

Remarks. — In  malignant  dysentery,  mercurius  sol. 
and  nitric  acid  are  unquestionably  remedies  of  the 
highest  importance.  In  all  cases  where  the  symptoms 
are  not  covered  by  one  of  them,  but  are  entirely  so 
by  both,  or  when  either  administered  singly,  does  not 
promptly  arrest  the  disorder,  we  may  use  them  in 
alternation  with  every  prospect  of  success. 

The  following  are  the  external  indications  of  nitric 
acid:  countenance  pale  or  flushed,  and  indicative  of 
anguish  and  anxiety  ;  evacuations  bloody,  slimy,  and 
fetid ;  abdomen  distended  ;  urine  red,  or  dark  and  tur 
bid  ;  body  hot,  while  the  extremities  are  perhaps  cold  ; 
pulse  hard  and  frequent. 

Physical  sensations. — Frequent  evacuations  with 
severe  tenesmus.  and  urging  to  urinate  ;  headache  ; 
fever  ;  thirst ;  sweat  during  the  night  and  occasionally 
in  the  day  time  ;  sense  of  fulness  and  pain  in  the 
abdomen  ;  general  character  of  the  disease  typhoid. 

Mental  and  moral  symptoms. — Sometimes  delirium ; 
or  anxiety,  fear,  apprehension,  depression,  and  sleep- 
lesness. 

Administration. — We  may  give  a  drop  of  the  second 
or  third  dilution  in  water,  after  each  evacuation  :  or 
when  used  in  alternation  with  mercurius,  after  every 
other  discharge  from  the  bowels. 

Mercurius  viv. — This  medicine  covers  the  same 
range  of  symptoms  as  the  mere,  sol.,  and  may  be  sub 
stituted  for  it,  if  desired,  in  the  treatment  of  dysentery. 
Its  mode  of  administration  is  also  the  same. 

Arsenicum  alb. — Where  dysentery  has  arisen  from 
the  abuse  of  drastic  and  other  debilitating  medicines, 
after  excessive  loss  of  blood,  or  after  the  organism  has 
been  enfeebled  from' previous  disease,  arsenicum  will 
often  prove  an  efficient  remedy.  It  is  also  peculiarly 
useful  in  dysenteric  affections,  occurring  in  individuals 
of  a  nervous,  dropsical,  or  lymphatic  constitution,  and 
when  the  disense  is  attended  with  typhoid  complica 
tions. 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  275 

External  indications. — General  appearance  of  de 
bility  and  prostration ;  trembling  or  stiffness  of  the 
limbs  ;  face  pale  or  yellowish,  hollow  and  cadaverous ; 
position  on  the  back,  with  tendency  to  sink  to  the  foot 
of  the  bed ;  eyes  dull  and  sunken  ;  lips  dry  and  dark- 
coloured;  tongue  dry  and  brownish  ;  abdomen  swollen 
and  hard,  or  tympanitic ;  faeces  offensive,  putrid,  and 
variable  in  colour,  but  generally  slimy  and  streaked 
with  blood,  or  greenish  or  darkish ;  skin  cold  and 
bluish,  or  dry  and  shrivelled ;  breathing  short  and  op 
pressed  ;  pulse  frequent,  small,  thready,  sometimes 
irregular. 

Physical  sensations. — Violent,  sharp  and  cramp-like 
pains  in  the  abdomen,  accompanied  with  nausea  and 
vomiting  ;  sensation  of  fulness  and  burning  in  the 
bowels  ;  frequent  eructations ;  flatulency  ;  frequent 
evacuations  with  some  tenesmus,  burning  pain  at  the 
anus,  and  nausea;  retention  of  urine,  or  burning  pain 
in  making  water  ;  pain  increased  by  the  slightest  mo 
tion  ;  faintness  upon  the  least  exertion  ;  great  tender 
ness  of  the  abdomen ;  colliquative  sweats ;  entire 
inability  to  sit  up,  or  make  any  effort ;  puffiness  of  the 
eyes  or  cheeks  ;  disturbed  sleep,  with  constant  jerking 
of  the  limbs,  and  tossing. 

Mental  and  moral  symptoms. — Sad ;  desponding  ; 
anxious;  discouraged;  irritability,  impatience;  de 
lirium  ;  loss  of  consciousness. 

Administration. — One  grain  of  the  first  trituration  to 
two  ounces  of  distilled  water — a  teaspoonful  once  in 
two  or  three  hours  until  the  required  effect  is  pro 
duced. 

Chamomela. — A  useful  remedy  in  dysenteric  affec 
tions  arising  from  a  sudden  chill,  from  difficult  and 
protracted  dentition,  from  violent  grief  or  passion.  It 
applies  especially  to  affections  of  this  nature  which 
occur  in  women  and  children,  and  when  judiciously 
prescribed,  will  often  act  promptly  and  efficiently. 
Laurie  has  found  it  of  service  after  aconite  in  cases 
attended  with  inflammatory  symptoms,  which  have 
been  partially  subdued  by  this  medicine.  It  may  be 
given  at  the  third  potency,  as  circumstances  require. 

Pulsatilla. — This  remedy  has  been  highly  recom 
mended  in  fall  dysenteries,  and  in  some  cases  of  chronic 


276  DISEASES    OP    THE    ORGANS    AND    TISSUES 

dysentery.  The  indications  for  its  use  are,  nausea, 
vomiting,  bad  feeling  in  the  head  ;  bruised  sensation 
in  the  integuments  of  the  abdomen ;  cutting  pains  in 
the  bowels,  with  discharges  of  sanguineous  mucus ; 
pain  in  the  small  of  the  back;  chilliness,  especially 
towards  night  ;  bad  taste  in  the  mouth ;  eructations, 
acid  or  bitter;  prickling  or  numbnesss  of  the  skin  ;  con 
stant  inclination  to  sleep  during  the  day  ;  yellow  tinge 
of  the  skin. 

Administration. — Four  drops  of  the  third  dilution 
to  an  ounce  of  distilled  water — a  dessert  spoonful 
every  two,  four  or  six  hours  in  acute  cases.  One  dose 
every  afternoon  in  chronic  dysentery. 

Colocynth  should  be  exhibited  in  cramp-like,  colicky 
pains  in  the  bowels,  with  inflammation  of  the  whole 
abdomen ;  slimy  or  bilious  evacuations,  with  pains 
and  contractions  at  the  rectum ;  bitter  taste,  with  ur 
gent  desire  for  cold  drinks  ;  nausea  and  vomiting  of 
bilious  fluids  ;  shooting  and  cramp-like  pains  on  one 
side  of  the  body;  pains  in  the  head,  and  throbbing  of 
the  temporal  arteries. 

Administration. — Same  as  chamomela. 

Nux  vom.  sometimes  effects  speedy  cures  in  protrac 
ted  dysenteric  discharges,  which  appear  to  be  kept  up 
from  relaxation  and  loss  of  tone  in  the  abdominal  mu 
cous  membrane  rather  than  from  actual  inflammation. 
By  imparting  tone  and  vigour  to  the  enfeebled  nerves 
of  the  stomach  and  intestines,  it  cures  the  disease,  and 
enables  these  organs  to  resume  their  healthy  functions. 
The  indications  for  its  employment  are,  fulness  antl 
disterition  of  the  abdomen  ;  contractive  or  cramp-like 
pains  in  the  umbilical,  epigastric,  or  hypochondriac 
region ;  frequent  small  evacuations  of  mucous  and 
bloody  matters  ;  contractive  pain  in  the  rectum  during 
the  discharges  ;  bowels  and  cheeks  hot ;  thirst ;  faeces 
putrid  and  offensive. 

Administration. — A  drop  of  the  third  potency  may 
be  given  every  two  to  six  hours,  as  the  urgency  of  the 
symptoms  demand,  until  an  impression  upon  the  dis 
ease  is  apparent. 

Another  medicine  which  has  proved  highly  servicea 
ble  in  my  hands,  is  aloes  soc.  The  indications  for  its 
use  are  similar  to  those  of  cohcynth  ;  .and  in  some 


CONNECTED    WITH    THE   DIGESTIVE    SYSTEM.  277 

cases  where  colocynth,  has  failed  to  afford  the  desired 
relief,  this  medicine  has  succeeded  promptly. 

Rau  has  also  used  aloes  with  distinguished  success 
in  purely  inflammatory  dysentery.  The  external  indi 
cations  are  :  abdomen  distended  and  tender  to  the 
touch  ;  stools  slimy  and  mixed  with  blood,  or  thin  and 
watery ;  urine  scanty  and  high-coloured ;  tongue  red 
and  dry  ;  pulse  full  and  rapid  ;  skin  hot  and  dry,  &c. 

Physical  sensations. — Severe  pressing,  cutting  and 
burning  pains  in  the  lower  part  of  the  abdomen  ;  vio 
lent  tenesmus  and  smarting  in  the  rectum,  during  the 
evacuations,  with  sharp  pains  extending  to  the  sacrum 
and  abdomen  ;  high  fever  ;  pain  in  urinating,  &c. 

Mental  and  moral  symptoms. — Anxiety  and  general 
indications  of  nervous  excitement. 

Administration. — Same  as  chamomela. 

Dulcamara  may  be  used  in  dysentery  arising  from 
cold,  and  attended  with  cutting  pains  in  the  intestines, 
bloody  discharges,  burning  and  itching  at  the  rectum, 
heat  of  skin  and  thirst.  It  may  be  prescribed  at  the 
third  potency — a  dose  once  in  two  to  six  hours,  accord 
ing  to  circumstances. 

Carbo  veg.  may  succeed  or  alternate  with  arsenicum 
in  certain  low  forms  of  dysentery,  when  the  former 
does  not  act  with  sufficient  efficiency.  It  may  be  given 
for  the  same  train  of  symptoms,  and  at  the  same  po 
tency  as  arsenicum. 

Sulphur  is  a  remedy  which  deserves  consideration 
in  instances  where  the  more  ordinary  remedies  fail  in 
affording  prompt  relief,  and  especially,  if  any  latent 
miasm  is  suspected  to  have  conduced  to  the  disease, 
or  prevented  the  usual  action  of  the  medicines  admin 
istered.  It  is  also  often  serviceable  in  the  dysenteries 
of  hasmorrhoidal  patients. 

Sulphuric  acidhas  been  highly  commended  inputrid 
dysentery.  The  external  indications  are  :  thin,  bloody, 
and  very  foetid  stools  ;  red,  or  darkish  urine,  turbid, 
or  depositing  a  dirty  sediment ;  burning  hot  skin  ; 
apthse;  petechise  ;  blood-blisters;  vomiting  of  water 
and  food. 

Physical  sensations. — Frequent  inclination  to  go  to 
stool,  with  severe  tenesmus,  nausea,  and  vomiting ; 
desire  for  acids,  fresh  fruit,  &e. 


278  DISEASES    OF    THE    ORGANS    AND    TISSUES 

Mental  and  moral  symptoms. — Indifferent,  or  irrita 
ble  ;  irascible  and  peevish.  It  may  be  given  in  the 
same  manner  as  nitric  acid. 

Belladonna  is  indicated  in  inflammatory  dysentery, 
with  determination  of  blood  to  the  head,  and  delirium. 
There  is  constant  tenesmus,  but  nothing  is  evacuated, 
with  violent  fever,  vomiting,  tympanitic  distention  of 
the  abdomen,  &c. 

In  bilious,  catarrhal,  erethistic,  and  rheumatic  forms  of 
dysentery,  examine  colocy.,  puls.,  nux  vom.,  cup.,cham., 
chin.,  rhus,,  sulph.,  ip.,  dale.,  euph.,  canth.,  ant.  crud., 
rheum. 

When  the  malady  degenerates  into  a  chronic  form, 
our  best  remedies  are,  phos.,  acid  nit.,  sulph.,  china, 
lach.,  acid  phos.,  calc.  carb.,  verat.,  mere. ,f err.,  and  colo- 
cynth. 

We  have  often  observed  the  most  decided  benefit 
follow  the  employment  of  enemata  of  cold  water,  in 
dysenteric  inflammations.  They  may  be  administered 
after  each  evacuation,  in  suitable  cases,  and  when 
they  afford  evident  relief. 

SECTION  XL 

ACUTE    PERITONITIS. 

Diagnosis. — Three  varieties  of  this  disease  have 
been  recognised,  viz. :  first,  natural  peritonitis  ;  second, 
puerperal  peritonitis  ;  third,  chronic  peritonitis.  We 
shall,  however,  include  under  the  present  head,  each 
variety,  detailing,  as  we  proceed,  the  characteristic 
symptoms  pertaining  to  all  of  the  different  forms  of  the 
malady. 

Acute  peritonitis  is  usually  ushered  in  with  more  or 
less  of  the  ordinary  symptoms  of  fever,  as  lassitude, 
irregular  chills, succeeded  by  flushes  of  heat,  headache, 
frequent  pulse,  uneasiness,  or  pressure  in  the  region  of 
the  stomach,  nausea,  and  loss  of  appetite.  These 
symptoms  are  speedily  succeeded,  and  occasionally 
accompanied,  by  a  pain  and  tenderness  in  the  abdo 
men,  either  confined  to  circumscribed  points,  or  uni 
versally  diffused  over  its  whole  extent.  Generally 
the  abdomen  is  excessively  tender  and  painful  upon 
pressure,  often  rendering  the  weight  of  the  bedclothes 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  279 

intolerable  ;  but  in  some  instances,  the  pain  is  slight 
from  the  commencement  to  the  fatal  termination  of 
the  malady.  The  tongue  is  moist  and  covered  with  a 
white  fur,  in  the  first  instance,  which  soon  becomes 
dark  and  dry  in  the  centre,  with  red  edges.  The 
bowels  are  constipated,  but  may  be  readily  acted  upon 
by  appropriate  remedies.  The  pulse  is  commonly 
frequent,  tense,  corded,  and  wiry,  though  in  some  in 
stances  it  varies  but  little  from  the  natural  standard. 
This,  like  most  other  inflammations  of  the  abdominal 
viscera,  imparts  to  the  countenance  a  contracted, 
sharp,  and  anxious  expression,  indicative  of  both  acute 
physical  and  mental  suffering.  The  patient  inclines 
to  relax  those  muscles  which  operate  upon  the  abdomi 
nal  parietes,  and  on  this  account  we  find  him  with  his 
legs  drawn  up,  his  head  and  shoulders  elevated,  and 
his  respiration  short,  imperfect,  and  exercised  almost 
entirely  by  the  muscles  of  the  chest. 

Puerperal  peritonitis  is  that  form  of  the  disease 
which  occurs  in  females  after  confinement,  and  is 
known  as  puerperal  fever.  It  differs  from  ordinary 
peritonitis,  in  being  more  sudden  and  violent  in  it's 
attack,  and  in  having  a  tendency  to  run  its  course  with 
greater  rapidity.  Among  the  first  symptoms  are  pain 
and  tenderness  in  the  hypogastric  region,  occurring 
soon  after  delivery,  and  succeeded  by  chills,  &c. 
Some  authors  assert  that  the  lochia  are  almost  inva 
riably  suppressed,  while  others  of  equal  eminence, 
assure  us  that  this  discharge  is  often  but  little  affected, 
and  never  entirely  suspended.  The  secretion  of  milk 
is  also  either  partially  or  entirely  suppressed  ;  and 
if  the  secretion  has  not  yet  taken  place,  it  does  not 
occur  at  all.  In  many  cases  of  both  forms  of  this  dis 
ease,  the  brain  is  affected  at  an  early  period,  and  de 
mands  special  attention. 

In  regard  to  the  precise  character  which  this  malady 
may  be  likely  to  assume,  much  will  depend  upon  the 
peculiar  constitution  and  circumstances  of  the  indi 
vidual,  the  season  of  year,  the  prevalence  of  epidemic 
or  contagious  influences,  &c.  "  There  is  also  an  en 
tire  extinction  of  the  maternal  feeling,"  (Deiuees,)  *  and 

*  Dr.  Dewees  considers  this  one  of  the  most  remarkable  circumstances 
attending  this  disease. 


280  DISEASE*    OF    THE    ORGANS    AND    TISSUES 

frequent  inclination  to  pass  water,  which  is  often  at 
tended  with  pain.  The  duration  of  this  malady  is 
from  twenty-four  hours  to  two  or  three  weeks. 

Chronic  peritonitis,  although  often  consequent  upon 
a  partially  subdued  acute  attack,  may  also  arise  inde 
pendently  from  sudden  changes  of  temperature,  insuffi 
cient  clothing,  irritating  fojod,  external  injuries,  sur 
gical  operations,  and  chronic  bowel  complaints.  Many 
of  the  symptoms  of  this  disease  are  like  those  of  dys 
pepsia,  as  sensation  of  fulness,  distention,  weight,  and 
occasional  pains  in  the  region  of  the  stomach  and 
bowels,  constipation,  loss  of  appetite,  depression  of 
spirits,  restlessness  at  night,  distress  and  pains,  aggra 
vated  after  eating,  emaciation,  thirst,  frequent  pulse, 
foul  tongue,  &c.  This  form  of  peritonitis  may  termi 
nate  in  a  few  weeks,  or  it  may  run  on  for  a  year  or 
more,  and  then  result  in  ulcerations  opening  into  the 
intestines. 

Causes. — Certain  occult  conditions  of  the  atmos 
phere,  undue  exposure  to  cold,  excessive  physical  ex 
ertion,  injuries,  labour,  miscarriage,  over-exertion  when 
the  organism  is  weakened  by  previous  disease,  atmos 
pheric  vicissitudes,  metastases  of  rheumatism,  and 
gout,  suppressed  discharges,  &c. 

Therapeutics. — The  most  approved  remedies  in  the 
treatment  of  peritonitis  are,  aconite,  belladonna,  bryonia, 
arnica,  bismuth.,  chamomela,  coffea,  colocynth,  ipecacu 
anha,  mercurius,  mix  vom.,  pulsatilla,  rhus  tox.,  sulphuris, 
veratrum. 

Administration. — We  advise  the  employment  of  the 
three  first  attenuations — and  a  repetition  of  the  dose 
every  one,  two,  or  three  hours,  according  to  the  ur 
gency  of  the  case. 

SECTION   XII. 

COLIC. 

Under  this  head,  we  shall  describe  three  varieties : 
first,  bilious  colic;  second, flatulent  colic;  third, pain- 
ter's  colic. 

1. BILIOUS    COLIC. 

Diagnosis. — The  first  symptoms  of  this  disease,  are 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  281 

headache  ;  nausea;  bitter  taste  ;  bilious  vomiting  ;  foul 
tongue  ;  loss  of  appetite  ;  thirst,  and  uneasiness  in  the 
bowels.  These  symptoms  are  speedily  followed  by 
severe  griping,  twisting,  or  shooting  pains  in  the  um 
bilical  region ;  hot  skin ;  painful  distention  of  the 
stomach  and  abdomen  ;  obstinate  constipation,  and 
finally,  tenderness  of  the  abdomen  ;  yellow  cast  of  the 
skin  and  eyes  ;  coldness  and  torpor  of  the  extremities  ; 
cold  sweats ;  feeble  or  extinct  pulse,  and  other  signs 
indicative  of  a  fatal  termination  of  the  disorder.  Du 
ring  the  first  stage  of  the  malady,  the  patient  involun 
tarily  makes  firm  pressure  over  the  navel,  which  af 
fords  temporary  relief,  and  it  is  by  this  symptom  that 
we  may  distinguish  the  disease  from  inflammation  of 
the  bowels,  in  which  pressure  is  attended  with  an  ag 
gravation  of  the  pain. 

Causes.*—  Deranged  function  of  the  liver,  is  supposed 
to  be  the  chief  cause  of  this  complaint,  but  what  the 
precise  nature  of  this  derangement  consists  in,  we 
know  not.  Dewees  supposes  that  the  liver  is  in  a  state 
of  morbid  activity,  and  secretes  bile  of  an  acrid  quality, 
which  serves  to  irritate  the  stomach  and  intestines, 
and  thus  induce  the  disease.  Gregory,  Eberle,  John 
son,  &c.,  assert  that  this  organ  is  in  a  torpid  condition, 
and  consequently  secreting  only  a  small  amount  of 
bile,  thus  leaving  the  ingesta  to  be  only  partially 
acted  upon  by  one  of  its  natural  solvents,  and 
thereby  rendering  the  half  digested  food  an  irritant 
to  the  digestive  organs.  From  the  fact  of  its  occur 
ring  only  at  particular  periods  of  the  year,  it  is  rea 
sonable  to  conclude  that  atmospheric  causes  exert 
some  influence  in  its  production. 

It  is  quite  evident,  however,  that  derangement  of 
the  liver  is  intimately  connected  with  genuine  bilious 
colic,  and  it  therefore  behooves  those  who  have  been 
afflicted,  to  take  every  precaution  to  ensure  a  healthy 
condition  of  this  organ. 

2. FLATULENT    COLIC. 

Diagnosis. — Flatulent  colic  may  be  distinguished 
from  the  variety  last  described,  by  the  greater  disten 
tion  of  the  stomach  and  bowels  with  flatus ;  frequent 
eructations ;  borborygmus ;  the  pain,  although  as  severe 


282  DISEASES    OF    THE    ORGANS    AND    TISSUES 

as  in  bilious  colic,  yet  coming  on  more  in  paroxysms, 
absence  of  nausea  and  bilious  vomiting,  and  from  the 
fact  that  it  usually  occurs  an  hour  or  two  after  eating 
something  indigestible, 

Causes. — Indigestible  food,  unripe  or  decayed  fruits  ; 
beer ;  mental  emotions,  or  any  other  cause  capable  of 
morbidly  altering  or  suspending  for  a  time,  the  healthy 
action  of  the  stomach  and  bowels,  in  such  a  manner 
as  to  cause  them  to  generate  an  unusual  quantity  of 
gas. 

3. COLICA    PICTONUM. PAINTERS  COLIC. 

Diagnosis. — Lead  colic  commences  with  feelings  of 
lassitude  ;  dull  pains  in  the  head  ;  loss  of  appetite  ;  bad 
taste  in  the  mouth  ;  wandering  pains  in  the  bowels 
and  limbs ;  transient  chills,  and  depression  of  spirits. 
After  these  symptoms  have  existed  for  some  time,  the 
pain  in  the  region  of  the  umbilicus  becomes  exceed 
ingly  severe,  obliging  the  patient  to  make  firm  pres 
sure  against  the  abdomen,  with  the  body  in  a  bent  posi 
tion  ;  indeed,  so  intolerable  is  the  pain,  that  the  patient 
is  unable  to  remain  quiet  in  any  position.  He  is  now 
in  a  state  of  great  agitation  and  excitement,  and  feels 
confident  that  he  must  die  unless  speedily  relieved.  It 
is  important  to  observe,  that  in  all  the  varieties  of  colic, 
the  skin  is  cool  or  not  above  the  natural  standard,  and 
sometimes  covered  with  a  cold  sweat.  The  pulse,  al 
so,  exhibits  but  little  arterial  excitement.  These  last 
symptoms,  together  with  the  relief  which  firm  pressure 
upon  the  abdomen  affords,  in  the  early  stages  of  the 
malady,  indicates  its  spasmodic  character,  and  will 
serve  to  distinguish  it  from  enteritis  and  other  inflam 
matory  conditions  of  the  abdominal  viscera. 

Therapeutics. — The  specifics  for  the  different  kinds 
of  colic,  are,  colocy  nth,  plumbum,  mix  vomica,  arsenicum, 
chamomela,  hyoscyamus,  stramonium,  veratrum,  cocculus, 
senna,  cokhicum,  phosphorus,  pulsatilla. 

Auxiliary  to  the  above  remedies,  we  beg  leave  to 
impress  upon  the  practitioner  the  importance  of  fo 
mentations  and  enemata  of  warm  water.  These  mea 
sures,  conjoined  in  certain  cases  with  the  tepid  bath, 
are  worthy  of  high  consideration,  and  should  never  be 
lost  sight  of  in  the  treatment  of  this,  as  well  as  other 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  283 

maladies  of  a  spasmodic  character.  The  fomentations 
should  not  only  be  applied  to  the  abdomen,  but  to  the 
extremities,  more  especially  if  these  parts  are  cold  and 
inclined  to  cramp.  In  moderate  cases,  fomentations, 
together  with  an  ordinary  enema,  and  the  proper  spe 
cific,  will  suffice  to  effect  a  speedy  cure ;  but  if  the 
case  has  been  very  violent  and  obstinate  from  neglect 
or  mismanagement,  by  calomel  and  opium,  a  general 
bath,  with  very  copious  injections  of  warm  water  while 
immersed  in  the  water,  cannot  be  too  highly  recom 
mended.  Indeed,  we  have  in  several  instances,  ob 
served  the  abdominal  spasms  to  relax,  the  pains  to 
cease,  and  free  evacuations  of  faecal  matter  and  of 
wind  to  occur,  while  the  patient  was  yet  in  the  bath. 
By  adopting  this  course,  we  secure  the  advantage  of 
internal,  as  well  as  external  fomentations,  and  thus 
bring  a  safe,  yet  efficient  remedy,  to  bear  directly  upon 
the  parts  affected.  All  who  have  practically  tested 
the  soothing  influence  of  warm  water  applications 
upon  the  nervous  system,  when  in  a  state  of  unnatural 
erethism,  will  appreciate  the  truth  of  our  remarks. 

The  medicine  which  is  most  generally  applicable  in 
the  treatment  of  colic,  is  colocynth.  It  is  particularly 
appropriate  when  the  complaint  has  been  caused  by  a 
chill,  by  mental  emotions,  as  grief,  indigestion,  morti-* 
fication,  &c.,  also  when  biliary  derangement  has  been 
the  exciting  cause. 

The  external  indications  are,  inflation  of  the  abdomen ; 
position  of  the  body  bent  forward,  so  as  to  relax  the 
abdominal  muscles  ;  cramps  in  the  calves  of  the  legs  ; 
general  agitation ;  temperature  of  the  skin,  about  the 
natural  standard,  or  cold  and  covered  with  sweat ; 
pulse  natural,  or  but  slightly  increased  in  frequency  ; 
tongue  covered  with  a  yellowish  fur,  or  natural ;  face 
pale  and  indicative  of  intense  suffering  ;  rigidity  and 
contraction  of  the  abdominal  muscles,  as  well  as  of  the 
tendons  in  other  parts  of  the  body. 

Physical  sensations. — Violent  cramp-like  contraction 
or  cutting  pains  in  the  abdomen,  generally  in  the  re 
gion  of  the  umbilicus  ;  painful  cramps  in  the  calves 
of  the  legs  ;  sensation  of  faintness,  with  coldness  and 
shuddering  ;  bitter  or  insipid  taste  in  the  mouth  ;  nau 
sea  ;  loss  of  appetite  ;  disgust  for  drinks  ;  constant  in- 


284  DISEASES    OF    THE    ORGANS    AND    TISSUES 

clination  to  move  about,  to  grasp  objects  violently, 
and  to  make  pressure  against  the  abdomen  ;  empty 
eructations  ;  pains  in  the  back  and  loins,  especially 
semilateral ;  obstinate  constipation,  or  small  and  loose 
evacuations. 

Mental  and  moral  symptoms. — Most  intense  anguish 
and  agitation  ;  dejection  ;  extreme  restlessness  and  de 
sire  to  move  about ;  fear  of  speedy  death. 

Administration. — From  the  first  to  the  sixth  dilution 
may  be  employed  according  to  the  age,  sex,  constitu 
tion,  temperament,  and  severity  of  the  disease.  A 
dose  may  be  given  every  half  hour  in  urgent  cases, 
until  amendment  or  medicinal  aggravation  occurs,  to 
be  resumed  and  repeated  as  the  exigencies  of  the  case 
may  require. 

Plumbum. — On  account  of  the  very  marked  and 
decided  specific  action  of  lead  upon  the  colon  and 
ileum,  whether  introduced  into  the  blood  through  the 
stomach,  rectum,  lungs,  or  skin,  this  drug  is  peculiarly 
appropriate  for  the  treatment  of  some  of  the  varieties 
of  colic.  The  practitioner  will,  of  course,  avoid  ex 
hibiting  it  in  that  variety  of  colic  which  has  been 
caused  by  the  absorption  of  lead.  The  following  are  its 

External  indications. — Rigidity  and  contraction  of 
*the  abdominal  muscles ;  hard  ridges,  or  elevations  in 
the  abdomen ;  borborygmus  ;  frequent  expulsion  of 
offensive  flatus  ;  eructations  ;  tremblings,  jerkings,  or 
cramps  of  the  limbs  ;  face  and  skin  pale,  bluish,  or 
yellow ;  surface  cold,  and  covered  with  clammy 
sweat ;  mouth  dry  or  moist,  and  clammy  ;  pulse  weak, 
and  somewhat  frequent ;  body  bent  double. 

Physical  sensations. — Violent  constructive,  shooting, 
or  pinching  pains  in  the  umbilical  region ;  constant 
and  urgent  desire  to  eructate  and  expel  flatus  ;  chilli 
ness  or  shuddering  during  the  paroxysms :  sensation 
of  faintness  ;  torpor,  numbness,  stiffness,  and  weak 
ness  in  the  limbs  ;  desire  to  press  the  abdomen  against 
something  hard  ;  extremities  cold ;  dizziness  ;  sweet 
ish  or  bitter  taste  ;  thirst ;  vomiting  of  bilious  or  faecal 
matters ;  pressure  and  cramps  in  the  stomach  ;  obsti 
nate  constipation  ;  evacuations,  scybalous  and  difficult 
to  expel ;  shooting  pains  in  the  loins,  and  back,  and 
limbs ;  cramps  in  the  feet,  excessive  agitation  and 
restlessness. 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  285 

Mental  and  moral  symptoms. — Very  great  anguish 
and  uneasiness  ;  melancholy  ;  discouragement  ;  im 
patience. 

Administration. — Same  as  Colocynth. 

Nux  vomica  is  very  useful  in  colic,  arising  from  tor 
por  of  the  liver,  indicated  by  deficient  secretion  of 
bile,  indigestion,  flatulence,  &c.  It  is  also  useful  in 
flatulent  colic,  occurring  in  dyspeptic  subjects  after 
the  use  of  improper  articles  of  food.  In  cases  where 
nux  is  indicated,  the  face  is  pale  or  yellowish,  the 
stools,  previous  to  the  attack,  light  and  clay-coloured, 
the  abdomen  distended,  there  are  frequent  eructations, 
hiccough,  sharp  and  cramp-like  pains  in  the  stomach 
and  bowels,  rumbling  in  the  bowels,  giddiness,  sen 
sitiveness  of  the  stomach  and  abdomen  when  pressed 
upon. 

Administration. — This  medicine  may  be  used  at  the 
second  or  third  attenuation  ;  a  dose  once  in  half  an 
hour  to  two  hours  until  relief  is  obtained. 

Arsenicum  is  specific  in  colic  pains  coming  on  in 
regular  paroxysms,  and  attended  with  decided  remis 
sions.  In  extreme  cases,  it  may  also  be  resorted  to 
with  advantage,  where  the  powers  of  the  system  have 
been  exhausted,  and  other  remedies  seem  to  be  inca 
pable  of  arresting  the  disease.  The  first  to  the  third 
potency  may  be  used,  and  repeated  as  circumstances 
appear  to  require. 

Chamomela  is  advised  by  Hahnemann  in  the  colics 
of  pregnant  and  parturient  women,  of  new-born  in 
fants,  and  of  children  during  dentition.  It  is  also  re 
commended  for  the  colics  of  nervous  and  hysterical 
females.  If  this  medicine  does  not  afford  the  desired 
relief,  resort  may  be  had  to  hyoscyamus,  stramonium, 
or  senna. 

Administration. — A  dose  of  the  third  to  the  sixth 
dilution  every  hour  or  two  as  long  as  necessary. 

Veratrum,  cocculus,  and  colchicum,  will  often  prove 
valuable  in  spasmodic  and  flatulent  colic  occurring  in 
nervous  and  hysterical  females,  and  in  persons  of  a 
mild  and  phlegmatic  temperament.  In  instances 
where  the  above  described  remedies  do  not  corres 
pond,  let  the  indications  of  these  articles  be  considered. 

Pulsatilla  is  principally  useful  in  colics  arising  from 


286  DISEASES  or  THE  ORGANS  AND  TISSUES 

the  abuse  of  crude,  esculent  vegetables,  unripe  fruits, 
and  abuse  of  fat  and  greasy  articles  of  food.  The 
pains  are  very  severe,  and  usually  occur  a  few  hours 
after  eating,  attended  with  borborygmus,  and  the 
expulsion  of  large  quantities  of  flatus.  We  have  often 
seen  the  most  prompt  relief  follow  a  single  drop  of 
the  tincture,  and  we  have  rarely  been  obliged  to  re 
peat  the  dose  more  than  two  or  three  times. 

Phosphorus  will  apply  to  cases  occurring  in  persons 
of  a  feeble  organization,  who  have  been  weakened 
by  long-continued  gastric  affections,  and  especially  for 
those  who  are  afflicted  with  disease  of  the  mesenteric 
glands.  A  dose  of  the  third  trituration  may  be  ad 
ministered  every  two  hours  until  relief  ensues. 

SECTION  XIII. 

ASIATIC    CHOLERA. 

When  the  Asiatic  cholera  first  pursued  its  destruc 
tive  course  amongst  the  millions  of  Europe  and  Amer 
ica,  the  disciples  of  the  ancient  school  of  medicine 
stood  aghast  and  almost  powerless  before  the  awful 
scourge,  their  best  resources  often  hastening  rather 
than  retarding  the  work  of  the  destroying  angel. 
Destitute  of  an  accurate  or  reasonable  system  of 
practice,  without  any  definite  rules  of  action,  or  any 
true  knowledge  of  the  operation  of  medicines,  the  al 
lopath  brought  to  the  treatment  of  the  malady  his 
vague,  indefinite,  and  uncertain  remedial  theories ; 
and  in  contemplating  the  numerous  and  contradictory 
modes  of  treatment  advised  and  adopted  by  different 
eminent  persons  of  this  description, — the  ridiculous, 
and  often  fatal  experiments,  by  means  of  which  they 
hoped  to  guess  out  and  blunder  on  to  some  actual  reme 
dy — we  are  forcibly  reminded  of  the  entire  worthless- 
ness  and  unsoundness  of  their  system.  Here  was  a  vio 
lent  and  relentless  enemy,  seizing  its  victim  with  un 
wonted  energy,  and  pursuing  its  deathly  course  with 
rapid  strides — one  requiring  active,  prompt,  and  de 
cided  processes  to  stay  its  fatal  ravages, — and  what 
course  did  the  allopath  adopt  in  the  fearful  crisis  ?  Did 
he  attack  symptom  after  symptom  with  medicines 
which  possessed  specific,  uniform,  and  decided  effects, 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  287 

and  thus  repel  the  invader  step  by  step  1  Did  he  ad 
minister  his  stimulants,  opiates,  mercurials,  and  coun 
ter-irritants  with  that  confidence  which  an  exact 
and  correct  system  of  medicine  must  naturally  inspire  ? 
Let  their  results  and  confessions  everywhere  answer. 

It  is  universally  conceded,  at  the  present  time,  that 
homoeopathy  is  far  more  efficient  in  the  treatment  of 
cholera  than  any  other  mode  of  practice.  During 
its  prevalence  in  Europe,  from  1831  until  its  disap 
pearance,  the  average  mortality  of  cases  under  this 
treatment  was  about  one  in  twelve,  while  under  allo 
pathic  treatment,  the  average  was  one  in  three.  In 
Germany,  Russia,  France,  and  other  European  king 
doms  where  our  system  had  become  known,  even  dis 
tinguished  gentlemen  of  the  old  school  were  forced  to 
admit  its  vast  superiority  over  their  own  system ;  and 
it  was  undoubtedly  this  superior  efficacy  and  success 
which  caused  so  many  distinguished  men  of  Europe  to 
investigate  the  claims  of  the  doctrine  of  "  similia  si- 
milibus"  renounce  the  fallacies  of  Hippocrates  and 
Galen,  and  throw  their  influence  on  the  side  of  truth. 

Being  a  disease  of  extreme  violence,  and  having  a 
tendency  to  run  its  course  with  great  rapidity,  there 
was  no  time  to  apply  remedies  according  to  the  prin 
ciple  contraria  contrariis,  nor  would  its  severity  per 
mit  the  additional  waste  of  strength  and  nervous 
energy  which  ever  follow  opiates,  stimulants,  and 
counter-irritants.  A  positive  specific,  a  real  antidote, 
could  alone  reach  the  seat  of  the  disease,  and  arrest 
its  progress  ;  and  to  the  disciples  of  Hahnemann  is 
due  the  credit  of  bringing  forward  these  specifics,  and 
demonstrating  to  the  world  their  tremendous  power 
and  efficiency  over  this  world-wide  scourge. 

Diagnosis. — Asiatic  cholera  varies  much  in  its  mode 
of  attack,  violence,  and  duration.  It  may  seize  its 
victim  in  such  a  manner  as  to  produce  an  immediate 
prostration  of  strength,  together  with  most  of  those 
symptoms  which  indicate  an  almost  total  loss  of  vital 
ity,  as  a  sunken  and  cadaverous  expression  of  counte 
nance,  small  and  almost  imperceptible  pulse,  surface 
of  a  bluish  tinge,  and  cold,  cramps  in  the  calves  of 
the  legs  and  fingers,  burning  in  the  stomach  and 
throat,  extreme  anguish  or  stupidity,  vomiting,  diar> 


288  DISEASES    OF    THE    ORGANS    AND    TISSUES 

rhoea,  and  an  almost  entire  loss  of  power  over  the 
voluntary  muscles.  Other  cases  set  in  with  vertigo, 
humming  in  the  ears,  oppression  and  burning  pain  at 
the  pit  of  the  stomach,  nausea,  vomiting,  griping,  and 
purging  of  a  liquid  resembling  "  rice  water,"  which 
are  soon  succeeded  by  oppression  of  the  chest,  diffi 
culty  of  breathing,  cramp-like  pains  in  the  extremities 
and  abdominal  muscles,  intense  thirst,  great  loss  of 
strength,  bluish  colour  of  the  lips,  nails,  and  skin, 
pulse  almost  imperceptible,  hippocratic  countenance, 
delirium,  cold,  icy  skin,  profuse  sweats,  weak,  hoarse 
voice,  and  sometimes  sopor,  with  eyes  half  open  and 
fixed,  with  partial  or  total  loss  of  consciousness.  A 
few  or  the  whole  of  these  symptoms  may  be  present 
in  any  given  case,  according  to  the  constitutional,  pre 
disposing,  and  exciting  causes  which  may  exist. 

Causes. — A.  peculiar  subtle"  poison,  capable  of  being 
conveyed  by  currents  of  wind  from  place  to  place, 
either  dissolved  in  aqueous  vapour,  or  in  some  other 
manner,  and  possibly,  by  attaching  itself  to  articles  of 
clothing,  &c.,  capable  of  communication  in  this 
way.  Whether  this  infinitesimal,  imponderable  mor 
bific  agent  is  generated  during  the  prevalence  of  some 
peculiar  conditions  of  the  atmosphere,  from  vegetable 
or  animal  matters  in  a  state  of  partial  or  total  decom 
position,  or  from  some  other  source,  is  as  yet  a  matter 
of  speculation.  Like  most  other  of  the  more  potent 
agents  in  nature,  the  particles  of  the  poison  are  in  so 
minute  a  state  of  subdivision,  and  so  subtilely  diffused 
in  the  air,  that  in  the  present  imperfect  condition  of  the 
sciences,  we  are  entirely  unable  to  investigate  or  appre 
ciate  their  nature.  That  the  cause  or  agent  is  material, 
however,  no  one  can  for  a  moment  doubt ;  for  it  must 
be  something  or  nothing ;  if  it  is  the  former,  it  must  be 
composed  of  minute  particles  or  atoms  of  matter, 
which,  by  being  absorbed,  produce  those  specific  ef 
fects  which  constitute  cholera.  If  it  is  contended  that 
the  cause  is  not  material,  but  simply  a  property  of 
matter;  something  spiritual,  unreal,  intangible,  and 
yet  capable  of  producing  powerful  impressions ;  we 
say  proofs  of  this  view  are  wanting,  and  we  reason 
upon  fallacious,  if  not  absurd  data.  We  hear  much 
said  respecting  the  "properties  of  matter"  when  ab- 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  289 

struse  subjects  are  the  topics  under  consideration,  and 
this  unmeaning  phrase  serves  the  purpose  of  explain 
ing  everything  which  is  obscure,  and  cannot  be  ex 
plained  by  the  existing  knowledge  concerning  the 
nature  of  certain  imponderable  substances.  Proper 
ties  of  matter  are  merely  effects  produced  upon  the 
organism  by  actual  contact  of  material  atoms,  and 
must  never  be  substituted  or  confounded  with  the 
agent — the  morbific  cause  itself.  Let  medical  men, 
therefore,  confess  their  ignorance  respecting  the 
causes  and  physical  character  of  those  imponderable 
atoms,  which  so  often  contaminate  the  atmosphere, 
and  by  being  absorbed  into  the  blood,  induce  those 
baneful  specific  diseases  which  so  sorely  afflict  man 
kind. 

Therapeutics. — Dr.  Lobethal,  of  Germany,  who  had 
charge  of  a  large  cholera  hospital  (allopathic)  during 
the  prevalence  of  the  epidemic  in  1831,  and  who 
treated  an  immense  number  of  cholera  patients  homce- 
opathically  in  the  summer  of  1847,  and  again  in  1819, 
observes  :  "  It  has  been  reserved  to  the  '  specific ' 
healing  art,  generally  known  under  the  name  of  ho 
moeopathy,  to  stand  the  test  of  practical  observation, 
and  to  demonstrate  its  superiority  in  combatting  this 
fearful  disease,  (cholera,)  the  appearance  of  which, 
followed  by  an  immense  number  of  well  substantiated 
cures,  has  tended  in  the  highest  degree  to  the  spread 
of  the  new  healing  art.  In  1831, 1  learned  from  experi 
ence  that  the  various  methods  of  treatment  pursued 
in  the  old  school,  in  spite  of  all  the  science  on  which 
it  was  based,  led,  on  the  average,  to  very  unfavourable 
results ;  whereas  in  1848  and  1849,  by  adopting  the 
homoeopathic  treatment,  /  lost  but  few  out  of  a  very 
great  number  of  patients." 

When  the  cholera  is  preceded  by  nausea  ;  loss  of 
appetite ;  constant  borborygmus ;  violent  thirst  ; 
slight  febrile  symptoms  ;  frequent  thin  watery  dis 
charges  ;  absence  of  pain  in  the  bowels,  and  other 
symptoms,  generally  known  under  the  term  "  chole 
rine"  Dr.  Lobethal  has  derived  marked  benefit  from 
the  use  of  phosphoric  acid,  repeated  every  two  or  three 
hours  until  the  symptoms  are  better.  If  the  above 
symptoms  are  attended  with  coated  tongue,  vomiting, 
13 


290  DISEASES    OF    THE    ORGANS    AND    TISSUES 

debility,  and   indigestion,  ipecac.,  of  the  third  dilution, 
is  required. 

When  cholera  has  actually  made  its  appearance,  a 
remedy  which  covers  the  exact  symptoms  of  the  case, 
ought  to  be  immediately  exhibited.  Our  best  reme 
dies  are  verat.,  ars.,  cup.,  camph.,  canth.,  curb.  v. 

In  the  forming  stage  of  cholera,  and  in  cholerine, 
with  cramps  in  the  calves  of  the  legs,  give  tincture  of 
camphor  ;  "  and  for  aching  or  burning  in  the  epigas 
trium,  ac.  phos.,  ars.,  cup.,  phos.,  ver.  ;  for  rumbling  in 
the  belly,  ac.  phos.,  ver.,  phos.  ;  for  diarrhoea,  ac.  phos., 
tors.,  ip.,  phos.,  sec.,  sulph.,  ver." — (Nusser). 

In  the  third  stage,  or  collapse,  ars.,  phos.,  verat., 
carh.  v.,  laurocer.,  &c.,  are  to  be  used. 

During  the  prevalence  of  the  epidemic  in  England 
and  France  in  1848-9,  and  in  America  in  1849,  almost 
every  individual  experienced  unusual  intestinal  irri 
tation  and  disposition  to  diarrhoea.  In  the  large  cities, 
especially,  very  few  exceptions  to  this  rule  could  be 
found.  Even  the  most  strict  regard  to  diet,  and 
avoidance  of  all  exposure,  was  no  security  against ' 
this  weakness  and  rumbling  of  the  bowels,  and  a  cer 
tain  lassitude  and  uneasiness  which  constantly  at 
tended  it.  Most  of  these  cases  subsided  without  any 
serious  disturbance ;  others  passed  into  cholerine,  which 
could  generally  be  controlled  when  promptly  taken  in 
hand  ;  while  those  cases  which  were  neglected,  or  im 
properly  managed,  usually  terminated  in  cholera.  In 
rare  instances,  individuals  would  be  attacked  sudden 
ly  and  violently,  without  any  apparent  premonitory 
symptoms,  but  cases  of  this  description  have  almost 
invariably  occurred  in  those  whose  constitutions  were 
impaired  from  intemperance,  disease,  o-r  who  had 
been  deprived  of  proper  repose,  by  mental  application, 
excitement,  fear,  &c. 

Dr.  Hencke  found  camphor  a  positive  specific  in  the 
spasmodic  form  of  cholera.  "  when  the  patients  were 
suddenly  taken  with  rigor,  and  even  cold  in  the  back, 
which  was  soon  followed  by  faintness  and  weakness, 
sinking  sensation  in  the  stomach,  vertigo,  nausea^ 
arching,  contracting  puiv.  in  the  epigastrium,  gagging, 
vomiting,  spasms  in  the  calves,  general  tonic  spasms, 
disappearance  of  the  natural  warmth,  therefore  cold- 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  291 

ness  of  the  hands  and  the  whole  body,  depression  of  the 
pulse,  which  could  hardly  be  felt,  lividity  of  the  lips, 
anxious  expression  of  the  countenance,  &c.,  sometimes 
diarrhasa."  Dr.  H.  advises  that  the  patient  be  well 
covered,  and  dry  heat  applied  to  his  body  and  limbs, 
and  that  strong  spirits  oi%  camphor  be  given  in  drop 
doses  every  five  minutes,  until  reaction  occurs,  warmth 
returns,  and  perspiration  sets  in.  Dry  frictions  may  at 
the  same  time  be  employed.  As  soon  as  we  observe 
signs  of  reaction,  we  must  either  omit  the  remedy,  or 
if  the  urgency  of  the  case  demands  further  remedial 
means,  give  the  camphor  at  the  first  or  second  dilution 
until  reaction  is  fully  established.  It  was  a  very  com 
mon  occurrence  for  patients  to  be  taken  in  the  night, 
generally  after  midnight,  with  cramps  in  the  stomach, 
nausea,  vomiting  and  purging  of  a  watery  fluid,  with 
out  pain  or  effort  on  the  part  of  the  patient ;  sense  of 
exhaustion  and  debility,  and  great  anxiety.  If  these 
symptoms  were  not  speedily  arrested,  there  soon  suc 
ceeded  extreme  prostration,  almost  constant  vomiting 
and  purging  of  rice-coloured  fluid ;  contractive  or 
burning  pains  in  the  stomach ;  coldness  of  the  sur 
face  ;  spasms  or  cramps  in  the  calves  and  other  parts 
of  the  body  ;  countenance  sunken,  altered  in  expres 
sion,  and  indicative  of  extreme  anxiety ;  voice  feeble 
or  hoarse  ;  marbled  appearance  of  the  skin  ;  skin 
shrunken  and  shrivelled  ;  cold  breath  ;  cold  and  pasty 
sweat ;  burning  thirst ;  marked  loss  of  power  in  the 
circulatory  and  respiratory  organs. 

Camphor,  veratrum,  arsenicum,  cuprum,  acid  hydro- 
cianic,  secale,  laurocerasus,  and  carlo  veg.,  have  been 
most  successful  in  the  epidemic  of  1848  and  1849, 
both  in  Europe  and  America. 

Dr.  Griesselich,  of  St.  Petersburgh,  considers  vera 
trum  by  far  the  most  important  remedy  in  cholera.  In 
Russia,  this  remedy  was  so  notoriously  efficacious, 
"  that  the  homoeopathic  drug  shops  were  overrun  by  al 
lopathic  physicians  and  druggists  to  procure  it." 

Dr.  G.  found  acid  phos.  exceedingly  efficacious  in 
cholerine. 

In  fully  developed  cholera  asphyxia,  as  it  occurred 
at  Breslau  in.  1848  and  1849.  Dr.  Schweikert,  of  Bres- 
lau,  found  ver.  first,  and  secale  first,  a  drop  every  five 


292  DISEASES    OF    THE    ORGANS    AND    TISSUES 

minutes,  in  alternation,  more  commonly  indicated  than 
any  other  remedies.  When  asphyxia  took  place,  Dr. 
S.  relied  upon  ac.  phos.,  either  alone  or  in  alternation 
with  secale  ;  but  in  a  few  cases  he  used  linct.  phos., 
first  or  second  dilution,  with  success. 

Probably  in  no  part  of  America  did  the  cholera 
rage  with  more  violence  in  1849,  than  at  Cincinnati, 
Ohio.  Two  physicians,  Drs.  Pulte  and  Ehrmann,  treat 
ed  1,116  genuine  cholera  patients,  in  all  stages  of  the 
disease,  and  with  a  loss  of  only  thirty-five — two  Amer 
icans  and  thirty-three  Germans.  These  gentlemen 
also  treated  1,350  cases  of  cholerine,  and  many  cases 
of  malignant  dysentery,  after  the  subsidence  of  the 
cholera,  without  the  loss  of  a  single  patient.  Of  the 
cases  of  genuine  cholera  asphyxia,  538  had  vomiting, 
diarrhoea,  and  cramps — 70  of  these  being  in  a  state 
of  collapse,  and  the  balance,  578,  presented  with  vo 
miting  and  rice-water  discharges.  These  last  being 
subjected  to  prompt  treatment,  were  speedily  re 
stored  without  the  supervention  of  more  serious  symp 
toms. 

The  treatment  adopted  by  Drs.  P.  and  E.  was  as 
follows  :  in  the  first  stage  of  the  malady,  tinct.  camphor, 
one  or  two  drops  every  five  minutes  for  one  to  two 
hours,  or  until  profuse  perspiration  ensued,  which 
should  be  kept  up  for  several  hours,  care  being  taken 
to  keep  the  patient  well  covered.  This  remedy  was 
perfectly  effectual  in  almost  every  case  during  the 
early  part  of  the  disease.  In  the  second  stage,  when 
cramps,  general  prostration,  and  rapid  sinking  of  the 
.physical  energies  appeared,  veratrum  when  the  cramps 
were  in  the  lower  extremities ;  cuprum,  if  in  the 
bowels  and  breast,  and  secale  cornutum,  were  relied 
on.  The  latter  medicine  was  found  of  eminent  serv 
ice  in  elderly  people.  In  cases  of  decided  collapse, 
arsenicum  and  carlo  veg.  were  the  remedies  em 
ployed.  Mild  frictions  of  the  extremities  with  the 
hands  alone,  were  the  onlv  external  means  made  use 
of. 

In  St.  Louis,  New  Orleans,  and  other  cities  of  the 
west  and  south,  a  similar  plan  of  treatment  was 
adopted  by  homoeopathic  physicians,  and  with  results 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  293 

which,  for  the  most  part,   compare    favourably  with 
those  detailed  by  Drs.  Pulte  and  Ehrmann. 

During  the  prevalence  of  cholera,  much  may  be 
done  towards  warding  off  its  attacks,  and  thus  disarm 
ing  it  of  a  portion  of  its  terrors.  The  most  important 
rule  which  we  would  inculcate,  is  the  cultivation  of 
presence  of  mind  under  all  circumstances,  cheerful 
ness,  contempt  of  danger,  and  strict  temperance  and 
regularity  in  all  the  habits  of  life.  Other  precautions 
are,  frequent  ablutions,  so  as  to  ensure  perfect  clean 
liness,  and  a  healthy  action  of  skin,  careful  ventilation, 
frequent  changes  of  body  linen,  moderate  and  agree 
able  exercise,  good  company,  and  a  clear  conscience. 

As  a  prophylactic,  many  European  authors  have 
highly  recommended  camphor  in  tincture,  in  doses  of 
a  drop  or  two  once  or  twice  in  twenty-four  hours. 
From  its  extensive  application  as  a  medicinal  anti 
dote,  we  are  disposed  to  believe  that  it  may  possess 
virtues  of  a  high  order,  as  an  antidote  against  the 
poison  of  cholera. 

The  medicines  which  have  been  found,  upon  the 
whole,  most  serviceable  in  the  treatment  of  this  ma 
lady,  as  it  occurs  in  different  localities,  and  in  its 
various  forms,  are,  veratrum,  cuprum,  arsenicum,  and 
camphor.  Symptoms  often  supervene,  also,  which  call 
for  the  exhibition  of  secede  cornutum,  nux  vomica, 
phosphorus,  phosphoric  acid,  ipecacuanha,  and  carlo 
veg. 

Veratrum. — External  indications.— General  coldness 
of  the  surface  of  the  body ;  cold  perspiration  on  the 
face,  and  sometimes  over  the  whole  surface  ;  skin 
white,  or  of  a  bluish  tinge;  bluish  colour  around  the 
nails,  and  of  the  lips  ;  contraction  of  the  muscles  of 
the  extremities  ;  nausea,  vomiting,  and  purging  ;  face 
pale,  sunken,  and  hippocratic  ;  nose  cold  and  pointed ; 
breath  cold ;  pulse  almost  imperceptible ;  general 
appearance  of  prostration. 

Physical  sensations. — Painful  cramps  in  the  limbs ; 
sensation  of  extreme  debility  and  faintness  ;  nausea  ; 
vomiting  and  purging ;  vertigo  and  confusion  in  the 
head  ;  constrictive  pain  in  the  throat ;  oppressive  and 
burning  pain  at  the  pit  of  the  stomach  ;  painful  con 
traction  of  the  abdomen  ;  oppression  in  the  chest ; 


294  DISEASES    OF    THE    ORGANS    AND    TISSCJES 

fulness  and  pressure  in  the  region  of  the  heart ;  ob 
structed  respiration ;  rumbling  and  griping  in  the 
bowels  ;  thirst ;  great  restlessness. 

Mental  and  moral  symptoms. — Excessive  dejection, 
anguish  and  despair  ;  constant  disposition  to  turn  from 
side  to  side,  or  otherwise  to  change  position  ;  some 
times  loss  of  memory  and  stupidity. 

Administration. — The  first  to  the  sixth  dilution  should 
be  employed,  a  dose  every  ten,  fifteen,  or  twenty 
minutes  in  urgent  cases,  and  extending  the  intervals 
as  the  symptoms  demand. 

Arsenicum  alb. — External  indications. — Skin  of  a 
pale  or  bluish  colour,  and  cold  ;  face  wan  and  cada 
verous  ;  eyes  sunken;  nose  pointed;  general  expres 
sion  of  countenance  unnatural  and  indicative  of  pain  ; 
lips  bluish,  or  black  and  dry ;  trembling  or  stiffness 
in  the  limbs ;  skin  cold  and  covered  with  a  clammy 
sweat,  or  dry  and  shrivelled  ;  pulse  very  weak,  irregu 
lar,  and  trembling ;  watery  discharges  by  vomiting 
and  purging. 

Physical  sensations. — Burning  pain  in  the  stomach, 
worse  after  vomiting  ;  cramps  in  the  calves  of  the 
legs,  toes  and  fingers  ;  dizziness  ;  nausea ;  frequent 
inclination  to  vomit  and  purge  ;  rumbling  in  the 
bowels ;  ringing  in  the  ears  ;  feeling  of  extreme  de 
bility  ;  very  great  restlessness  and  agitation  ;  intense 
thirst,  which  affords  but  slight  relief;  spasmodic  con 
traction  and  burning  in  the  throat  and  oesophagus ; 
cramp-like  pains  in  the  stomach  and  abdomen ;  fre 
quent  desire  to  pass  water,  or  retention  of  urine  ;  diffi 
culty  of  respiration,  with  hoarseness ;  general  sensation 
of  coldness  and  loss  of  vitality. 

Mental  and  moral  symptoms. — Intense  anguish,  anx 
iety  and  discouragement ;  dread  of  death ;  constant 
uneasiness  ;  confusion  of  ideas  ;  delirium. 

Administration. — The  lower  potencies  of  this  medi 
cine  should  be  used,  and  in  urgent  cases,  the  doses 
may  be  repeated  once  in  fifteen  or  twenty  minutes  un 
til  the  symptoms  yield.  Some  writers  extol  it  highly 
in  alternation  with  veratrum,  and  where  either  of  these 
remedies  does  not  afford  prompt  relief  by  itself,  by  all 
means  let  them  be  given  in  alternation. 

Camphor. — It  is  not  alone  as  a  prophylactic  that  this 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  295 

medicine  has  been  advised.  Hahnemann  made  use  of 
it  in  all  stages  of  cholera,  but  he  found  it  particularly 
successful  in  the  first  stages  of  the  malady,  when  ver 
tigo,  extreme  weakness,  cramps  in  the  calves  of  the 
legs  and  muscles  of  the  abdomen,  burning  and  heat 
in  the  stomach,  convulsive  distortion  of  the  features, 
eyes  sunken,  face  and  hands  bluish  and  cold,  anguish, 
dulness,  loss  of  consciousness,  and  hoarse  ness,  were  pre 
sent.  It  has  been  found  most  useful  in  those  cases 
which  have  been  almost  entirely  unattended  with  nau- 
sea,vomiting,  and  diarrhoea.  It  has  in  some  instances  re* 
stored  patients  who  were  apparently  in  articulo  mortis. 

Secale  corn,  and  cuprum  are  appropriate  remedies 
when  there  are  distortion  of  the  limbs;  jerking  and  con 
vulsive  movements  in  the  limbs  ;  great  desire  to  sleep  ; 
great  coldness  in  the  back,  abdomen,  and  limbs ;  cold 
clammy  perspiration ;  suppression  of  urine,  and  pains 
in  the  extremities. 

Nux  vomica  may  be  used  when  the  principal  suffer 
ings  seem  to  be  in  the  stomach,  as  anguish  and  op 
pression  at  the  pit  of  the  stomach,  and  severe  spasms 
in  the  stomach,  also  tenesmus  with  an  increase  of  the 
spasms  at  each  discharge. 

In  some  severe  cases  where  the  previous  remedies 
have  failed  to  afford  relief,  the  practitioner  should  take 
into  consideration,  phos.,  phos.  acid,  ipecac.,  carb.  veg. 
canth.,  sulph.  ether,  chloric  ether,  fyc. 

SECTION  XIV. 

SPORADIC    CHOLERA. CHOLERA    MORBUS. 

Diagnosis. — Distressing  nausea  and  vomiting,  with 
great  fulness  and  oppression  at  the  stomach ;  severe 
griping  or  colic  pains  in  the  umbilical  region  ;  frequent 
watery  discharges;  twisting  and  cramps  in  the  ab 
dominal  muscles  and  calves  of  the  legs  ;  tongue  slight 
ly  furred ;  pulse  quick  and  weak ;  countenance  ex 
pressive  of  suffering  and  anxiety. 

Causes. — Torpor  of  the  liver ;  obstruction  of  the  bil 
iary  ducts ;  unripe  or  decayed  fruits ;  crude  esculent 
vegetables  ;  constant  exposure  to  a  cold  and  damp  at 
mosphere. 

Therapeutics. — The  most  efficacious  medicines  in  the 


296  DISEASES    OF    THE    ORGANS    AND    TISSUES 

treatment  of  this  complaint,  are,  veratrum,  arsenicum, 
colocynth,  chamomela,  pulsatilla,  ipecacuanha. 

Veratrum  alb. — External  indications. — Countenance 
pale  or  bluish,  cold  and  disfigured  ;  eyes  sunken  ;  nose 
pointed  ;  mouth  parched,  lips  dry  or  cracked,  and  of  a 
dark  colour ;  surface  cold,  or  hot  and  dry ;  contraction 
of  the  muscles  of  the  abdomen  and  extremities  ;  pulse 
frequent  and  very  weak  ;  cold  sweats  ;  evacuations 
watery,  light,  greenish,  or  brownish. 

Physical  sensations. — Severe  cutting  pain  in  the  um 
bilical  region ;  violent  nausea  and  vomiting,  with 
diarrhoea  ;  burning  sensation  in  the  stomach  ;  speedy 
rejection  of  food  or  drinks  ;  stomach  and  abdomen 
tender  on  pressure ;  cramps  in  the  abdomen  and  in 
the  extremities ;  extreme  prostration  ;  great  oppres 
sion  and  distress  at  the  stomach  ;  intense  thirst  ;  gen 
eral  uneasiness. 

Mental  and  moral  symptoms. — Excessive  anguish  ; 
fear  of  death  ;  despair  of  recovery  ;  delirium. 

Administration. — This  medicine  may  be  used  at  from 
the  first  to  the  third  dilution — a  dose  every  half  hour, 
in  urgent  cases,  until  the  requisite  impression  is  pro 
duced.  In  slight  cases,  two  or  three  doses  of  the  third 
dilution,  at  intervals  of  two  to  four  hours,  will  suffice 
for  the  cure. 

Arsenicum  alb. — The  indications  for  this  remedy  are 
somewhat  similar  to  those  of  veratrum,  but  it  is  espe 
cially  useful  when  the  disease  is  violent  from  the  com 
mencement,  attended  with  an  almost  immediate  pros 
tration  of  strength  ;  trembling  of  the  limbs ;  severe 
burning  pain  in  the  stomach  ;  constant  nausea  and 
vomiting  ;  diarrhoea  ;  ringing  in  the  ears ;  vertigo ; 
giddiness  ;  great  anguish  and  restlessness ;  skin  dry 
or  cold,  and  bluish  ;  hippocratic  countenance  ;  eyes 
sunken,  dim,  and  suffused ;  thirst ;  distress  from  swal 
lowing  the  blandest  liquids  ;  tongue  and  lips  dry,  dark, 
and  cracked ;  breath  cold  ;  excessive  anguish,  anxiety 
and  despair. 

Administration. — Same  as  veratrum. 

Colocynth  will  occasionally  serve  us  in  cases  attend 
ed  with  moderate  nausea,  vomiting  and  purging  ;  vio 
lent  cramp-like  pains  in  the  region  of  the  navel ; 
cramps  in  the  extremities  ;  tongue  loaded  with  a  yel- 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  297 

low  fur ;  bitter  taste  in  the  mouth  ;  great  dejection 
and  anxiety,  and  general  restlessness.  It  may  be 
given  at  the  third  potency  every  two  hours,  gradually 
lengthening  the  intervals  as  the  pains  subside. 

Chamomela  has  been  highly  recommended  when  the 
disease  has  been  "  excited  by  a  fit  of  passion."  The 
symptoms  which  point  to  this  remedy,  are,  frequent 
vomiting  of  food,  or  of  mucous,  sour,  or  bitter  substan 
ces  ;  great  anguish  and  pressure  at  the  pit  of  the  stom 
ach  ;  cramps  in  the  calves  of  the  legs  when  lying  down ; 
tearing  and  cutting  pains  in  the  abdomen. 

Administration. — Same  as  colocynth. 

Pulsatilla  is  chiefly  useful  in  cholera  which  has  been 
induced  by  the  abuse  of  fat,  crude,  and  indigestible 
food.  In  cases  of  this  description,  it  is  often  promptly 
serviceable,  administered  at  the  first  or  second  dilu 
tion,  as  circumstances  require. 

Ipecacuanha  is  the  remedy  when  vomiting  is  the 
most  prominent  and  troublesome  symptom.  It  may 
be  given  at  the  third  potency  every  half  hour,  until 
the  symptoms  abate — afterwards,  as  the  exigences  of 
the  case  demand. 

SECTION  XV. 

DIARRHCEA. 

Diagnosis. — Looseness  of  the  bowels,  with  or  with 
out  griping  pains  ;  discharges  feculent,  or  thin  and 
watery  ;  respiration,  circulation,  skin,  and  the  organs 
generally  in  a  natural  condition. 

Causes. — Dentition,  worms,  irritating  articles  of 
food,  cold,  mental  emotions,  hectic  fever,  repelled 
eruptions,  epidemic  influences,  &c. 

Therapeutics. — For  the  diarrhoeas  which  supervene 
during  dentition,  suitable  remedies  will  be  found  in 
chamomela,  ipecacuanha,  dulcamara,  mercurius,  sulphur, 
calcarea  card.,  rheum,  coffea,  and  aconite. 

When  the  disease  has  been  caused  by  the  use  of  fat 
and  indigestible  food,  and  the  discharges  are  pulta- 
ceous,  mucous,  liquid,  or  foetid,  attended  with  burning 
or  excoriation  of  the  anus,  nausea,  regurgitation,  colic, 
and  aggravation  of  the  symptoms  in  the  night,  p-ulsa- 
satilla  is  appropriate. 

Duknwara  is  a  remedy  of  the  very  highest  value, 

13* 


298  DISEASES    OF    THE    ORGANS    AND    TISSUES 

in  diarrhoeas,  and  it  covers  a  much  wider  range  of 
symptoms  than  has  generally  been  attributed  to  it. 
It  has  been  employed  principally  in  watery  diarrhoeas, 
which  have  arisen  from  cold ;  but  we  have  used  it 
with  distinguished  success  in  bowel  complaints  which 
have  been  caused  by  teething,  worms,  repelled  erup 
tions,  errors  in  diet,  &c.,  and  in  which  there  were  mu 
cous,  slimy,  bilious,  greenish  and  sanguineous  evacua 
tions.  Dr.  Rummel  expresses  the  opinion  that  nine- 
tenths  of  all  cases  of  diarrhoea  may  be  cured  with  dul 
camara,  and  we  are  satisfied  that  he  is  not  very  wide  of 
the  mark.  It  may  be  employed  in  the  first  or  second 
dilution,  and  given  in  drop  doses,  with  water,  after  each 
evacuation. 

If  the  complaint  appears  to  be  characterized  by 
prominent  biliary  derangement,  specific  medicines 
will  be  found  in  mercurius,  chamomela,  pulsatilla,  nux 
vom.,  arsenicum,  and  bryonia. 

If  the  discharges  are  mucous,  slimy,  or  sanguineous, 
and  preceded  and  accompanied  by  griping  and  tenes- 
mus,  our  best  remedies  are,  acid  nit.,  and  mercurius  sol., 
in  alternation.  We  may  use  the  third  attenuations, — 
a  dose  after  each  evacuation.  Other  remedies  are, 
arsenicum,  ipecacuanha,  sulphur,  acid  phos.,  acid  sulph., 
petroleum,  colocynth,  veratrum,  phosphorus,  and  dulca 
mara. 

\.  For  the  diarrhoeas  which  supervene  during  dentition, 
suitable  remedies  will  be  found  in  chamomela,  calcarea 
carb.,  ipecacuanha,  rheum,  magnesia  carb.,  coffea,  dul 
camara,  mercurius,  sulphur. 

When  bowel  complaints  arise  in  consequence  of 
violent  mental  emotions,  we  employ  chamomela,  ignatia, 
colocynth,  veratrum,  antimonium  crud.,  coffea,  mix  vom., 
phosphorus,  arsenicum,  pulsatilla,  and  ferrum. 

If  the  discharges  can  be  traced  to  the  presence  of 
worms,  we  give  sulphur,  cina,  spigelta,  aloes,  mercurius, 
nux  vom.,  carbo  veg.,  ferrum. 

For  the  diarrhoeas  which  occur  during  hectic  fevers, 
especially  if  connected  with  a  scrofulous  dyscrasia,  the 
appropriate  medicines  are,  sulphur,  calcarea  carb.,  acid 
nit.,  acid  phos.,  iodine,  ferrum,  mercurius,  sepia,  katmia. 

For  painless  chronic  diarrhoea,  we  suggest  phospho 
rus,  ferrum,  veratrum,  china,  natrum  mur.,  acid  nit.,  sul 
phur,  lachesis,  lycopodium.  graphite,  arsenicum. 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  299 

When  the  diarrhoea  occurs  during  dentition  and  is 
connected  with  some  chronic  cutaneous  affection,  it 
will  be  necessary  to  exhibit  sulphur,  either  alone,  or 
in  alternation  with  dulcamara,  chamomela,  or  mercurius. 
It  has  not  unfrequently  occurred  to  us,  that  after  mer 
curius,  chamomela,  and  other  apparently  appropriate 
medicines  have  failed  in  arresting  the  relax,  a  few 
doses  of  sulphur  has  either  put  a  stop  to  the  malady, 
or  placed  the  system  in  such  a  condition  that  it  will 
respond  readily  to  the  remedies  first  employed. 

Administration. — Our  attenuations  may  range  from 
the  first  to  the  sixth — one  drop,  if  a  dilution,  or  a  grain, 
if  a  trituration,  after  each  evacuation. 

SECTION  XVI. 

HAEMORRHOIDS. PILES. 

Diagnosis. — This  very  common  and  troublesome 
complaint  will  probably  demand  the  attention  of  the 
physician  more  frequently  than  any  other  single  mala 
dy  ;  nor,  when  we  consider  the  causes  which  originate 
it,  and  their  almost  constant  and  universal  prevalence, 
shall  we  be  surprised  at  this.  Any  cause  which 
operates  upon  the  rectum  in  such  a  manner  as  to  im 
pair  the  integrity  of  its  vascular  and  muscular  struc 
tures,  may  induce  the  disease.  The  effects  in  these 
cases  are,  a  permanent  dilatation  of  the  veins,  and  a  re 
laxation  of  the  mucous  membrane  of  the  part,  causing 
tumours  of  various  sizes,  at  the  verge  of  the  anus,  and 
within  the  rectum,  and  in  some  instances,  a  protrusion 
of  a  portion  of  the  rectum  itself.  When  this  last  result 
obtains,  we  are  presented  with  the  disease  known  as 
prolapsus  ani. 

Hsemorrhoidal  tumours  may  be  external  or  internal — 
hard  or  soft — sensible  or  insensible.  Their  general 
appearance,  in  regard  to  colour,  size,  &c.,  will  depend 
much  upon  the  amount  of  inflammation  present,  the 
causes  which  have  been  in  operation,  and  the  length 
of  time  which  has  elapsed  since  the  commencement 
of  the  malady.  During  a  *'  fit  of  the  piles,"  the  tumours 
are  usually  red,  or  purple,  inflamed,  and  painful,  the 
pain  is  of  a  severe  kind,  aggravated  to  an  almost  in 
tolerable  degree  when  at  stool,  and  accompanied  by 

'^TI®%\ 

±     THE        *J\ 

UNIVERSITY  3 


300  DISEASES    OF    THE    ORGANS    AND    TISSUES 

tenesmus  and  frequent  discharges  of  blood.  The  lo 
cation  and  character  of  the  pains  vary  much  in  dif 
ferent  cases,  being  sometimes  confined  to  the  tumours 
themselves,  and  at  others  extending  upwards  into  the 
intestines,  or  into  the  perineum,  down  the  thighs,  &c. 
The  pains  may  be  itching,  burning,  aching,  throbbing, 
darting,  or  shooting — constant,  or  only  when  at  stool, 
or  on  sitting  down. 

When  the  mucous  membrane  of  the  rectum  is  much 
relaxed,  we  almost  always  have  as  a  complication, 
prolapsus  ani.  Although  this  complaint  sometimes 
originates  independently  of  any  haemorrhoidal  en 
largements,  in  the  majority  of  cases  the  two  diseases 
are  conjoined  ;  and  this  is  explicable  from  the  circum 
stance  that  the  causes  of  both  are  generally  the  same. 
The  most  common  of  these  causes  is  habitual  constipa 
tion,  induced  for  the  most  part,  by  the  reprehensible 
practice  of  inattention  to  daily  alvine  evacuations. 
We  have  before  observed  that  the  protracted  presence 
of  indurated  faecal  matters  in  the  rectum  gives  rise  to 
a  semi-paralytic  condition,  which  impairs  the  tone  of 
the  parts,  and  thus  induces  constipation,  piles,  and  pro- 
lapsus  ani.  The  evils,  then,  to  which  this  condition  of 
the  lower  bowels  give  rise,  may  be  summed  up  as  fol 
lows  :  first,  constipation,  and  the  numerous  and  grave 
consequences  which  often  result  from  it.  in  the  form  of 
determinations  of  blood  to  the  brain,  lungs,  and  intes 
tinal  canal ;  also  mania,  hypochondria,  neuralgia, 
dyspepsia,  bowel  affections,  colic,  fistula  in  ano,  &c. ; 
second,  piles,  and  its  train  of  unpleasant  symptoms ; 
third,  prolapsus  ani. 

Causes. — Other  causes  of  these  affections,  in  ad 
dition  to  the  one  already  mentioned,  are  abuse  of  ca 
thartics  which  operate  specifically  upon  the  lower 
portion  of  the  intestinal  tube,  excessive  exercise  on 
horseback,  long  continuance  in  tho  standing  posture, 
or  in  certain  other  constrained  positions,  protracted 
bowel  complaints,  general  debility,  dyscrasias,  seden 
tary  habits,  indulgence  in  highly  seasoned  food,  wines 
and  liquors. 

Therapeutics. — The  first  object  with  the  physician  in 
the  treatment  of  haemorrhoids,  should  be  to  ascertain 
the  cause  or  causes  upon  which  the  malady  depends. 


CONNECTED  WITH    THE    DIGESTIVE   SYSTEM.  301 

so  that  immediate  and  efficient  measures  may  be 
taken  to  remove  them.  In  a  majority  of  instances  the 
disease  is  unquestionably  connected  with  constipation  ; 
which  should  therefore  receive  a  due  share  of  atten 
tion.  Nothing  can  remove  the  torpid  condition  of  the 
bowel,  upon  which  the  constipation  depends,  unless  all 
indurated  faecal  matters  be  removed  daily,  in  order 
that  sufficient  time  may  elapse  to  enable  the  debilita 
ted  parts  to  recover  their  impaired  tone.  The  first 
step  necessary  to  secure  this  result,  is  to  adopt  suitable 
dietetic  regulations.  In  many  instances  this  alone 
will  suffice  to  regulate  the  bowels,  and  thus  to  remove 
all  traces  of  the  haemorrhoidal  affection.  Amongst 
the  articles  of  food  which  we  particularly  commend 
in  these  cases,  is  bread  made  from  unbolted  wheat.  A 
liberal  and  daily  use  of  this  highly  nutritious  substance, 
and  of  other  articles  of  a  similar  character,  with  an 
occasional  indulgence  in  ripe  and  wholesome  fruits, 
will  often  surpass  our  most  sanguine  expectations  in 
abolishing  diseases  of  the  rectum.  Should  these  sim 
ple  means  alone  prove  ineffectual  after  a  thorough  trial, 
we  may  then  call  in  the  aid  of  enemeta  of  cold  water. 
This  last  resource  will  rarely  disappoint  us,  provided 
the  case  is  recent,  and  the  cause  has  not  been  very  long 
in  operation.  When  the  ha^morrhoidal  tumours  are 
much  inflamed  and  very  painful,  great  service  will  fre 
quently  be  derived  from  external  applications  of  cold 
water,  and  in  some  instances,  of  ice  enclosed  in  a  linen 
cloth,  and  applied  to  the  parts  as  long  as  may  be 
deemed  expedient.  In  troublesome  cases  of  prolapsus 
ani,  also,  these  applications  and  injections  will  some 
times  afford  prompt  relief. 

The  medicines  which  are  entitled  to  the  highest  con 
sideration  in  the  complaints  under  consideration  are, 
mix  vcmica,  sulphur,  rhus  toxicod.,  sepia,  bryonia,  ly  co- 
podium,  opium)  pulsatilla,  aloes,  carbo  regetabilis,  and 
calcarea  carb. 

Nux  vomica  is  appropriate  when  the  disease  has 
been  caused  by  inactive  and  sedentary  habits,  high 
living,  or  the  depressing  mental  emotions,  and  is  at 
tended  by  constipation,  prolapsus,  and  general  loss  of 
power  over  tho  muscular  structure  of  the  recturr. 


302  DISEASES    OF    THE    ORGANS    AND    TISSUES 

The  second  or  third  trituration  may  be  employed — one 
grain  every  night  as  long  as  is  deemed  expedient. 

Sulphur  is  well  adapted  to  cases  occurring  in  indi 
viduals  tainted  with  syphilis,  scrofula,  psora,  or  mer 
cury.  If  the  piles  bleed  frequently  and  profusely,  and 
there  exists  considerable  inflammation  of  the  surround 
ing  mucous  membrane,  with  darting  pains  up  the 
bowel,  tenesmus,  discharges  of  mucus  or  of  faecal  mat 
ters  mixed  with  blood  and  mucus,  this  medicine  will 
generally  prove  effective.  It  should  be  given  at  the 
third  attenuation — one  grain  morning  and  evening 
until  the  desired  effect  is  produced. 

Rhus  tox.,  in  alternation  with  sulphur  or  nux,  has 
been  eminently  useful  in  piles  and  prolapsus  conjoined, 
which  appeared  to  be  connected  with  some  latent  impu 
rity  of  the  blood.  We  are  accustomed  to  use  the  first  or 
second  attenuations  in  these  cases — giving  a  dose  daily, 
and  changing  the  medicine  every  other  week. 

When  the  haemorrhoidal  tumours  protrude,  and  are 
inflamed,  red  and  painful,  with  profuse  haemorrhage 
during  each  evacuation,  we  may  consider  acid  nit., 
acid  mur.,  aloes,  calcarea  carb.,  and  sepia. 

If  the  disease  arises  during  pregnancy,  and  constipa 
tion  is  unusually  obstinate,  we  advise  pulsatilla,  opium, 
bryonia  and  platina. 

Administration. — This  malady  responds  most  satis 
factorily  to  the  first,  second,  and  third  attenuations — 
given  in  grain  or  drop  doses  once  or  twice  in  twenty- 
four  hours. 

SECTION  XVII. 

ACUTE    HEPATITIS. INFLAMMATION    OF    THE    LIVER. 

Diagnosis. — When  the  disease  occupies  the  convex 
surface  of  the  liver,  we  shall  have  fulness  and  severe 
pain  in  the  region  of  the  liver,  increased  on  pressure, 
either  of  a  sharp,  aching,  or  burning  character  ;  pains 
extending  into  the  chest,  under  the  clavicle,  between 
the  shoulder  blades,  into  the  top  of  the  right  shoulder, 
and  sometimes  down  the  arm ;  short,  dry  cough ; 
dyspnrea  ;  difficulty  in  lying  upon  the  left  side  ;  hot 
and  dry  skin  ;  thirst  ;  scanty  and  high- coloured  urine  ; 
constipation  ;  clay-coloured  evacuations  ;  full,  hard, 


CONNECTED    WITH    THE    DIGESTIVE    SYSTEM.  303 

and  frequent  pulse  ;  headache,  and  more  or  less  men 
tal  disorder.  If  the  inflammation  is  in  the  concave 
portion  of  the  liver,  we  shall  have,  in  addition  to  the 
symptoms  already  enumerated,  distressing  nausea  and 
•^omiting  ;  tongue  covered  with  a  white  or  yellow  fur  ; 
bitter  taste  ;  urgent  thirst;  an  aggravation  of  the  pain 
in  the  hypochondrium  on  pressure  ;  urine  scanty,  and 
of  a  dark  yellow  or  saffron  colour  ;  eyes  and  skin 
tinged  with  yellow  ;  bowels  constipated  or  relaxed  ; 
pains  in  the  back  and  limbs ;  ideas  confused ;  mind 
clouded  or  delirious. 

In  most  instances  of  acute  hepatitis,  it  is  highly 
probable  that  the  peritoneal  covering  of  the  liver  is 
implicated  to  a  greater  or  less  extent,  and  this  may 
serve  to  render  the  pains  more  severe,  and  the  accom 
panying  symptoms  more  violent. 

CHRONIC    HEPATITIS. 

Diagnosis. — The  symptoms  of  chronic  liver  com 
plaint  are  somewhat  similar  to  those  of  the  acute 
form,  but  much  more  mild  in  their  character.  For 
example,  the  pain  in  the  right  hypochondrium  is  dull, 
heavy,  and  dragging,  that  in  the  shoulder  and  arm  of 
a  vague  and  heavy  kind;  the  skin  is  somewhat  hot 
and  dry ;  the  tongue  furred  ;  the  countenance  and 
albuginea  yellow  ;  the  urine  and  perspiration  of  a 
dark  or  yellowish  colour  ;  the  bowels  costive,  some 
times  alternating  with  relax  ;  evacuations  light ;  oc 
casional  cramp-like  pains  in  the  stomach ;  great 
weakness  and  loss  of  energy  throughout  the  entire 
system  ;  inclination  to  sleep  a  good  part  of  the  time  ; 
trembling  of  the  knees  on  the  slightest  exercise  ;  de 
jection  and  indifference  to  life  ;  enlargement  and  in 
duration  of  the  liver. 

Causes. — This  is  a  disease  of  hot  rather  than  of 
temperate  latitudes,  and  may  arise  from  a  too  free  use 
of  animal  food,  stimulating  drinks,  and  other  articles 
abounding  in  carbon.  As  the  blood  passes  through 
the  liver,  its  office  is  to  separate  the  carbon,  <fcc., 
which  is  not  wanted  in  the  system.  We  can,  there 
fore,  readily  perceive  how  prone  this  important  organ 
must  be  to  be  overtasked,  in  so  rarefied  a  tempera 
ture,  unless  the  utmost  care  is  taken  to  retain  the  or- 


304  DISEASES    OF    THE    RESPIRATORY  ORGANS. 

gans  in  a  healthy  state,  as  well  as  to  avoid  highly 
seasoned  animal  food,  stimulants,  &c, 

The  chronic  form  of  hepatitis  often  follows,  and  is 
a  consequence  of  dyspepsia.  Indeed,  there  are  but 
few,  if  any,  cases  of  the  latter  disorder,  which  are 
entirely  unattended  with  derangement  of  the  liver. 

Want  of  exercise,  depression  of  spirits,  misfortune, 
sudden  suppression  of  perspiration,  accustomed  dis 
charges,  &c.,  may  often  exercise  a  powerful  influence 
in  inducing  this  disease. 

Therapeutics. — Aconite,  mercurius,  china,  eupatorium, 
perfoliatum,  mix  vomica,  bryonia,  sulphur,  conium,  ta 
raxacum,  pulsatilla,  lachesis. 

Administration. — The  medicines  may  be  used  from 
the  first  to  the  sixth  attenuations,  and  repeated,  in 
acute  cases,  every  two,  four,  or  six  hours  according  to 
circumstances.  In  chronic  hepatitis,  a  dose  of  the 
appropriate  specific  should  be  given  once  or  twice  in 
the  twenty-four  hours,  at  the  same  time  inculcating 
the  importance  of  rigid  dietetic  regulations. 

In  chronic  hepatitis,  there  is  a  peculiarly  dry  and 
harsh  state  of  the  skin,  and  on  this  account  we  strong 
ly  advise  the  daily  use  of  cold  sponging,  or  bathing,  to 
be  followed  by  vigorous  exercise,  in  order  that  the 
pores  may  be  opened,  and  the  cutaneous  functions 
thus  restored. 


CHAPTER  XXIII. 

DISEASES  OF  THE  RESPIRATORY  ORGANS. 

GENERAL    OBSERVATIONS. 

In  all  of  our  investigations  touching  affections  of 
the  lungs  and  their  appendages,  whether  acute  or 
chronic,  a  few  preliminary  inquiries  are  essential,  in 
order  that  we  may  be  able  to  arrive  at  accurate  opin 
ions  respecting  the  seat,  nature,  treatment,  and  proba- 
bl?  termination  of  each  particular  case.  Although 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  305 

we  are  to  be  governed,  as  a  general  rule,  by  symptoms, 
yet  certain  constitutional  or  accidental  peculiarities, 
connected  with  a  given  train  of  symptoms,  might  in 
duce  us  to  select  one  specific  in  preference  to  another, 
which  was  equally  homoeopathic  to  the  disease.  Thus, 
cough,  copious  expectoration,  pains  in  the  chest,  and 
tickling  in  the  throat,  &c.,  which  had  followed  imme 
diately  upon  the  suppression  of  some  chronic  eruption, 
might  be  completely  covered  by  bryonia,  ipecacuanha, 
phosphorus,  phosphoric  acid,  staphysagria,  silicea,  &c., 
so  far  as  the  mere  symptoms  are  concerned  ;  but  who 
would  not  prefer,  in  cases  of  this  description,  sulphur, 
or  some  other  specific  which  would  have  a  tendency 
to  reproduce  the  eruption,  while,  at  the  same  time,  it 
would  be  perfectly  homoBopathic  to  these  indications  ? 
So  in  regard  to  temperament,  habits  of  life,  occupa 
tion,  medicinal  symptoms,  age,  sex,  climate,  &c.,  our 
remedies  should  always  be  selected  in  such  a  manner 
as  to  bear  upon  any  occult  miasm,  or  other  latent 
cause  which  may  be  operating  upon  the  organism, 
and  thus  either  directly  or  indirectly  aggravating  and 
complicating  the  apparent  symptoms. 

When  called  to  treat  lung  diseases,  therefore,  let 
the  physician  inquire,  first,  Is  there  any  hereditary  pre 
disposition  on  the  part  of  the  patient  to  scrofula,  con 
sumption,  dropsy,  erysipelas,  nettle-rash,  syphilis,  &c.? 
Second,  Is  the  chest  well  developed  and  symmetrical,  so 
that  the  lungs  can  have  ample  room  to  perform  their 
functions?  Third,  Is  the  subject,  during  health,  put 
out  of  breath  by  slight  exertion  ?  Fourth,  Has  the  ma 
lady  supervened  on,  or  shortly  after  the  disappear 
ance  of  an  eruption  ?  Fifth,  Do  all  parts  of  the  chest 
dilate  equally  and  properly  during  inspiration,  and  is 
the  respiration  natural  during  health  ? 

Respecting  this  last  question,  it  is  proper  to  observe 
that  a  difference  of  opinion  exists  amongst  authors, 
Laennec  considering  respiration  natural  •'  when  the 
anterior  and  lateral  parts  of  the  chest  dilate  equally, 
distinctly,  yet  moderately,  during  inspiration,  and 
when  the  number  of  inspirations,  in  a  state  of  repose, 
is  from  twelve  to  fifteen  in  the  minute  ;"  while  An- 
dral,  Broussais,  Miiller,  Forbes,  and  others,  suppose 
that  Laennec  has  placed  the  mean  number  of  inspi- 


306  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

rations  too  low.  These  gentlemen  assure  us  that  the 
"  mean  average  of  respirations  is  more  than  sixteen 
or  eighteen  in  the  minute,  in  the  healthy  adult,  and 
that  most  persons  in  health  breathe  from  eighteen  to 
twenty-four  times  in  a  minute."  From  much  obser 
vation  in  reference  to  this  subject,  we  are  disposed  to 
adopt  the  opinion  of  Laennec,  rather  than  that  of 
Andral,  &c.,  and  therefore  estimate  the  mean  number 
of  respirations  in  a  healthy  adult  at  fifteen  or  sixte-en 
in  a  minute. 

We  beg  leave  in  this  place  to  recommend,  in  strong 
terms,  the  use  of  auscultation  and  percussion  in  the 
investigation  of  chest  diseases,  if  for  no  other  reason 
than  to  form  an  accurate  diagnosis  and  prognosis.  In 
order  to  acquire  skill  in  the  use  of  the  stethoscope, 
percussion,  &c.,  a  patient  and  careful  course  of  study 
and  practice  upon  both  healthy  and  diseased  subjects, 
is  indispensable.  By  this  means,  the  physician  will  be 
able  to  pronounce  with  certainty  the  seat  and  nature 
of  the  malady,  and  its  probable  termination.  As  we 
advance  in  our  descriptions  of  the  different  affections 
of  the  respiratory  organs,  we  shall  point  out  the  pe 
culiar  sounds  elicited  by  percussion  and  auscultation, 
in  the  several  varieties  of  disease. 

SECTION  I. 

CATARRH,  CORYZA,  OR  COLD. 

Diagnosis. — This  disease  consists  of  an  inflamma 
tion  of  the  mucous  membrane  lining  the  frontal 
sinuses  and  the  nostrils.  It  usually  commences  with 
lassitude,  a  sense  of  coldness,  slight  shiverings,  sneez 
ing  ;  dull  and  heavy  feeling  in  the  head,  succeeded  in 
a  short  time  by  lachrymation  ;  more  or  less  obstruc 
tion  in  the  nose  ;  sense  of  fulness,  or  pain  in  the 
region  of  the  frontal  cavities ;  swelling  or  inflamma 
tion  of  the  nostrils  ;  nose  dry  and  tender,  or  constant 
discharge  of  mucus,  of  a  mild,  burning,  or  corrosive 
character  ;  eyes  inflamed,  watery,  and  sensitive  to 
light ;  buzzing,  or  roaring  in  the  ears  ;  drowsiness, 
heaviness,  and  dull  pains  in  the  head ;  chills,  alter 
nating  with  flushes  of  heat ;  pains  and  soreness  in  the 
limbs  and  bones ;  thirst,  worse  in  the  night ;  cold 


DISEASES    OP    THE    RESPIRATORY    ORGANS.  307 

sores  upon  the  lips ;  stupid,  languid,  and  indifferent, 
or  irritable  and  ill-humoured. 

When  the  inflammation  extends  to  the  mucous 
membrane  of  the  throat,  larynx,  and  trachea,  it  has 
received  the  name  of 

INFLUENZA,    (iNFLUENZE     DELL    ARIA,)    OR,    INFLUENCE    OF 
THE    COLD. 

In  addition  to  the  symptoms  just  enumerated,  we 
have,  febrile  symptoms ;  hoarseness  ;  severe  cough, 
either  dry  and  racking,  or  hollow  and  loose  ;  wheezing, 
or  difficult  respiration  ;  impaired  appetite  ;  soreness, 
oppression,  or  stitches  in  the  throat  and  chest  on 
coughing ;  incapacity  for  mental  or  physical  exertion  ; 
bowels  constipated  or  relaxed. 

Sometimes  the  inflammation  appears  to  extend  to 
the  membrane  of  the  thorax  and  of  the  bronchial 
tubes,  giving  rise  to  sharp,  stitching  pains,  or  a  sen 
sation  of  rawness  in  these  parts,  severe  and  painful 
chest  cough,  thick,  tenacious,  and  semi-purulent  ex 
pectoration,  oppression  of  the  chest,  and  difficult  res 
piration.  In  these  instances,  the  inflammation  is  of  a 
lower  grade  than  obtains  in  acute  bronchitis,  pleuritis, 
or  laryngitis,  and,  consequently,  the  symptoms  are 
more  slight  and  less  dangerous.  In  some  cases,  the 
disease  commences  with  soreness  and  burning  in  the 
scorbiculus  cordis,  which  gradually  extends  to  the 
chest  and  throat,  nose  and  head,  when  coryza,  ob 
struction  of  the  nose,  and  other  signs  of  influenza, 
manifest  themselves. 

Therapeutics. — The  chief  remedies  are,  nux,  arseni- 
cum,  mercurius,  dulcamara,  ammonium,  carbon,  ipecac 
uanha,  causticum,  belladonna,  bryonia,  pulsatilla,  chamo- 
mela.  When  the  complaint  is  attended  with  marked 
febrile  excitement  from  the  first,  our  treatment  should 
always  commence  with  aconite ;  but  when  the  local 
symptoms  manifest  themselves  without  much  consti 
tutional  disturbance,  we  may  commence  with  the  ap 
propriate  local  specific  immediately. 

For  common  cold,  with  evening  chills,  sneezing, 
free  discharge  of  thick,  yellow,  green,  or  offensive 
matter,  loss  of  smell,  taste,  and  appetite,  pain  and 
fulness  in  the  region  of  the  frontal  sinuses,  pulsatilla 
is  specific. 


308  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

Drs.  Shue  and  Taft  have  found  tartar  emetic,  at  the 
first  or  second  attenuation,  the  most  efficient  remedy 
in  the  early  part  of  the  influenzas  which  usually  pre 
vail  in  this  region. 

Nux  vomica,  ipecacuanha,  and  arsenicum,  will  also 
be  found  appropriate  in  many  instances  of  the  com 
plaint,  as  it  occurs  in  this  latitude. 

My  friend,  Dr.  Shue,  has  employed  sabina  with 
excellent  success  in  several  cases  of  chronic  catarrh 
occurring  in  females.  The  cases  which  have  responded 
the  most  promptly  to  this  remedy,  have  been  those  in 
which  the  catarrhal  discharge  appeared  to  alternate 
with  leucorrhcea,  disappearing  when  the  fluor  albus 
was  profuse,  and  returning  again  at  every  suppres 
sion  or  material  diminution  of  the  discharge. 

If  hoarseness  be  an  attendant  symptom,  and  pro 
ceeds  from  an  inflammation  of  the  mucous  membrane 
of  the  larynx,  causticum,  bryonia,  capsicum,  carbo  veg., 
mercurius,  rhus  tox.  and  belladonna  are  our  best  re 
medies. 

When  the  hoarseness  has  arisen  from  loss  of  tone 
of  the  nerves  of  the  throat,  an  alternation  of  carbo 
veg.  with  mix  vom.,  will  usually  prove  curative.  Bel 
ladonna,  causticum,  and  mercurius  will  also  occasion 
ally  demand  our  attention. 

"  Hoarseness,  with  bruised  and  pricking  sensation 
in  the  larynx,  coryza,  moist  cough,  pain  in  the  chest, 
and  complete  loss  of  voice,  responds  to  pulsatilla." — 
Croserio. 

Administration. — We  usually  prescribe  from  the  first 
to  the  third  attenuations  ;  the  doses  to  be  repeated,  in 
severe  cases,  once  in  two  to  four  hours,  according  to 
circumstances,  and  in  chronic  cases,  once  or  twice 
daily. 

SECTION  II. 

CYNANCHE    TRACHEALIS. CROUP. 

Until  the  present  century  this  disease  was  confound 
ed  with  hooping  cough,  asthma,  and  bronchitis,  and 
the  fatal  cases  were  supposed  to  be  violent  forms  of 
one  of  these  maladies. 

In  the  hands  of  the  allopath,  croup  has  ever  proved 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  309 

a  most  formidable  and  fatal  disease.  Acting,  in  the 
application  of  their  remedial  measures,  only  indirectly 
upon  the  part  affected,  by  venesection,  leeches,  blisters, 
emetics,  mercurial  cathartics,  expectorants,  &c.,  it  is 
not  a  matter  of  surprise  that  they  are  so  often  baffled 
in  subduing  a  malady  of  so  violent  a  character  as  the 
one  under  consideration. 

It  is  especially  in  diseases  of  this  nature,  that  the 
truth  and  value  of  a  system  of  practice  may  be  satis 
factorily  tested  ;  for  it  is  here  that  a  prompt,  efficient, 
and  specific  remedy  is  imperatively  demanded,  in  order 
that  the  progressing  inflammation  may  be  at  once  ar 
rested,  and  the  patient  saved.  These  are  the  cases 
which  try  the  truth  and  soundness  of  a  theory  :  which 
convince  the  public, — who  appreciate  facts,  if  they  do 
not  comprehend  abstruse  theories — which  school  pos 
sess  the  knowledge  and  skill  that  should  command 
approbation  and  support.  On  the  result  of  these  tests 
we  are  willing  to  rest  the  claims  of  homcBOpathy. 
Indeed,  the  records  of  the  homoeopathic  practice  show 
conclusively  a  large  balance  in  its  favour,  over  the 
other  systems,  in  all  maladies  of  an  acute  as  well  as 
chronic  character. 

Croup  rarely  occurs  after  the  age  of  seven  years, 
and  may  therefore  be  accounted  a  disease  almost  pe 
culiar  to  childhood.  Its  seat  is  the  mucous  membrane 
of  the  larynx,  trachea  and  bronchia,  and  sometimes 
of  the  fauces  and  palate. 

Diagnosis. — Croup  may  with  propriety  be  divided 
into  ^wo  principal  varieties,  viz.  :  first,  the  false, 
pseudo,  or  non-membranous  ;  comprising,  however,  un 
der  this  head,  the  spasmodic,  catarrhal,  and  slightly 
inflammatory  kinds  ;  and  second,  the  true,  or  mem 
branous  croup. 

Some  recent  writers  have  distinguished^bwr  distinct 
varieties,  each  one  forming  a  distinct  and  independent 
disease,  and  not  liable  to  run  into  either  of  the  other 
forms. 

It  is  doubtless  true  that  these  several  varieties  do 
often  exist  as  distinct  and  clearly  defined  maladies, 
and  that  the  remedies  homoeopathic  to  these  varieties 
are  also  entirely  distinct,  but  we  are  by  no  means  cer 
tain  that  the  different  forms  do  not  run  into  each  other. 


310  DISEASES    OP    THE    KESPIRATORY    ORGANS. 

Be  this  as  it  may,  it  is  of  importance  that  an  accu 
rate  knowledge  should  be  acquired  respecting  the 
seat,  nature  and  symptoms  of  the  malady  in  all  its 
forms,  so  that  we  can  exhibit  without  delay  a  remedy 
which  shall  be  truly  specific  and  homoeopathic.  First, 
False  or  non-membranous  croup. 

Spasmodic  croup  usually  makes  its  appearance  sud 
denly,  with  considerable  difficulty  of  breathing,  noisy 
and  wheezing  inspirations,  a  short,  dry,  hoarse  cough, 
occurring  but  rarely,  and  an  entire  absence  of  febrile 
symptoms. 

Catarrhal  croup  also  commences  suddenly,  with  a 
"  croupy  cough,  hoarse  voice,  shrill,  wheezing,  and 
sonorous  inspirations,  oppression  and  tightness  at  the 
chest,  and  sudden  attacks  of  dyspnoBa  ;  but  in  a  few 
days  the  croupy  character  will  wear  off  of  itself,  leaving 
simple  catarrhal  symptoms  only." — (Watson.) 

In  the  simple  inflammatory  croup,  in  addition  to  the 
loud,  harsh,  and  wheezing  respiration,  and  hoarse, 
croupy  cough,  we  have  usually  sore  throat,  some  thirst, 
and  nightly  febrile  exacerbations.  This,  like  the  pre 
ceding  variety,  will  often  wear  off  spontaneously, 
leaving  only  some  slight  symptoms  behind. 

An  important  peculiarity  of  all  the  varieties  of  false 
croup,  consists  in  the  suddenness  of  their  attacks. 
Children  may  retire  to  their  beds  in  the  most  perfect 
health,  and  yet  in  an  hour  or  two  be  disturbed  from  a 
sound  sleep  with  an  apparently  alarming  attack  of 
croup.  It  is  important,  however,  that  all  should  be 
aware  that  these  seemingly  dangerous  cases  are  much 
less  to  be  dreaded  than  those  which  make  their  ap 
pearance  in  a  more  slow  and  insidious  manner,  as  will 
be  seen  by  the  following  description  of  the  true  croup. 
In  all  of  the  varieties  above  described,  although  there 
may  be  very  difficult,  laboured,  anxious,  and  wheezing 
respiration,  hoarse,  harsh,  and  croupy  cough,  hoarse 
voice,  and  the  patient  may  seem  to  be  in  imminent 
danger  of  suffocation,  yet  the  fact  that  the  attack  has 
occurred  suddenly,  and  that  the  cough  bears  no  re 
semblance  to  the  dreadful  metallic  cough  of  real  croup, 
will  afford  us  sure  indications  of  its  nature,  and  enable 
us  to  assure  those  interested  that  the  attack  will 
speedily  be  subdued. 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  311 

Second,  True  or  membranous  croup  is  usually  ushered 
in  with  the  ordinary  symptoms  of  catarrh,  as  chilliness, 
sneezing,  some  soreness  of  the  throat,  hot  skin,  thirst, 
slightly  accelerated  pulse,  hoarse  voice,  and  some  little 
impediment  in  respiration.  At  this  period  a  whistling 
or  "  buzzing  sound  may  be  heard  at  the  rima  glottidis, 
by  placing  the  ear  upon  the  back  of  the  neck,  or  over 
the  larynx." — (Ware.)  Even  at  this  early  period  the 
commencement  of  the  false  membrane  may  be  ob 
served  upon  the  tonsils,  and  sometimes  upon  the  uvula 
and  pharynx,  \vhich  gradually  increases  in  thickness 
and  strength  unless  the  peculiar  inflammation  be  ar 
rested. 

As  the  disease  advances,  the  febrile  symptoms  in 
crease,  the  respiration  gradually  becomes  more  la 
boured  and  difficult,  the  inspirations,  particularly  after 
coughing,  being  slow,  sawing,  sonorous  or  ringing, 
while  the  expirations  are  quick,  the  cough  is  dry  and 
gives  forth  a  metallic  sound,  the  voice  becomes  more 
shrill,  the  pulse  is  frequent  and  small,  the  expression 
of  countenance  swollen  and  anxious,  the  head  is  thrown 
back,  the  extremities  are  cold,  while  the  rest  of  the 
body  retains  its  exalted  temperature,  there  is  often  a 
profuse  perspiration,  until  finally  the  respiration  is  so 
much  impeded  that  the  blood  is  but  slightly  oxygena 
ted,  the  cheeks  and  lips  become  livid,  the  eyes  red  and 
sunken,  the  pulse  extremely  small  and  frequent,  the 
whole  organism  prostrated,  and  the  child  expires  in  a 
state  of  asphyxia  or  suffocation. 

In  membranous  croup  the  inflammation  is  of  a  pe 
culiar  character  ;  for  from  the  very  commencement 
of  the  attack,  the  mucous  membrane  continues  to  pour 
out  coagulable  lymph,  which  becomes  adherent  to  the 
parts  affected,  forming  the  tough  artificial  tube  known 
as  the  false  membrane.  We  believe  that  the  progress 
of  this  fictitious  formation  is  never  entirely  arrested 
until  a  healthy  medicinal  inflammation  is  made  to 
supersede  the  peculiar  morbid  action. 

"  The  false  membrane  which  so  frequently  forms  on 
blisters,  is,  of  itself,  sufficient  to  prove  that  it  is  much 
less  to  the  degree  than  to  the  nature  of  the  inflamma 
tion,  that  we  are  to  attribute  this  concretion  or  coagu 
lation  of  pus  in  certain  cases." — (Laennec.) 


312  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

Causes. — A  cold  and  damp  atmosphere,  wet  feet, 
and  exposure  to  the  air  which  blows  from  seas  and 
lakes.  It  appears  to  be  necessary  also  that  there 
should  be  a  certain  predisposition  on  the  part  of  the 
patient,  in  order  to  contract  the  disease,  since  all  of 
the  children  of  some  families  are  constantly  liable  to 
its  attacks,  while  those  of  other  families,  constantly 
exposed  to  precisely  the  same  influences,  are  exempted. 
This  predisposition  may  frequently  be  traced  back 
through  several  generations,  while  in  other  families 
the  reverse  is  true,  no  instances  of  the  malady  having 
ever  been  known  to  exist  in  them.  Croup  sometimes 
follows  as  a  sequence  of  scarlatina,  measles,  &c.,  and 
has  by  some  writers  been  confounded  with  the  former 
disease,  and  from  this  circumstance  has  originated  the 
idea  of  its  contagious  nature. 

Therapeutics  : 

Spasmodic  croup. — Aconite,  spongia,  hyoscyamus, 
belladonna,  nux,  musk,  cuprum,  ipecacuanha,  camphor 
and  lobelia  inflat. 

Catarrhal  croup. — Aconite,  tartar  emetic,  spongia, 
hepar  sulph,  drosera,  lachesis,  sambucus,  chamomile,  and 
nux. 

Simple  inflammatory  croup. — Aconite,  spongia,  hepar, 
tartar  emetic,  phosphorus,  iodine,  and  belladonna. 

True  or  membraneous  croup. — Kali,bichrom,  bromine, 
ammonia,  caustic,  hepar  sulph.,  argentum  nit.,  sambucus, 
spongia  and  iodine,  senega,  tartar  emetic. 

We  introduce  the  following  excellent  indications  for 
the  employment  of  spongia,  hep.  sulph.,  bromine,  caustic 
ammon.,  bichrom,  and  potash,  arranged  by  several  ho- 
moBopathic  physicians  in  Pressburgh,  and  translated 
by  Ch.  J.  Hempel,  M.  D.,  for  the  Homooeopathic  Ex 
aminer. 

SPONGIA — CROUP. 

"  Hollow  cough  ;  with  expectoration  ;  with  pain  in 
the  chest  and  trachea ;  roughness  in  the  throat ; 
(night-cough  with  weeping  expression) ;  breathing  ag 
gravated,  as  from  a  plug  in  the  throat,  slow  or  quick  ; 
panting ;  larynx  painful,  as  if  from  pressure — worse 
when  touched  ;  scratching,  burning,  and  constrictive 
sensation  in  the  larynx  ;  painful  feeling  of  swelling  in 


B1SBASES   <OF    THE    RESPIRATORY    ORGANS,  313 

£he  cervical  glands  near  the  larynx  and  trachea; 
stinging  in  the  throat  and  sensation  in  the  outer 
parts  of  the  neck,  as  if  something  were  pressing  out, 
morning  and  evening  ;  painful  tension,  on  the  left  side 
of  and  near  the  apple  of  Adam,  when  turning  the 
head  to  the  right  side  ;  the  eyes  are  sunken  ;  the  urine 
deposits  a  thick,  grayish- white  sediment;  general 
•morning  sweat;  pulse  quick  and  hard;  drowsiness; 
lassitude  of  the  whole  body;  out  of  humour;  every 
thing  puts  him  out  of  humour,  even  talking  and  an 
swering  questions." 

KEPAR    CROUF. 

"  Violent  fits  ef  cough,  as  if  one  would  suffocate  or 
vomit;  deep;  occasioned  by  tightness  of  breathing; 
fiusky,  accompanied  with  painful  soreness  of  the 
chest  at  every  turn  of  cough ;  violent ;  the  air  rushing 
violently  against  the  larynx,  which  causes  a  pain  in 
that  part ;  scraping ;  scratching ;  with  mucous  ex 
pectoration  ;  the  cough  being  occasioned  by  titillation 
in  the  throat,  or  by  a  scraping  in  the  trachea; 
increased  unto  vomiting  by  a  deep  inspiration; 
weakness  of  the  organs  of  speech  and  chest,  pre 
venting  her  from  talking  aloud;  short  breathing; 
pressure  in  the  throat,  occasioning  a  constrictive  feel 
ing,  as  if  he  should  be  suffocated ;  urine  pale,  clear 
while  being  emitted,  afterwards  becoming  turbid  and 
thick,  depositing  a  white  sediment:  or  flocculent,  tur 
bid  while  being  emitted;  dark-yellow :  burning  dur 
ing  emission  ;  great,  unconquerable  drowsiness  ;  pro* 
fuse  sweat  day  and  night ;  viscid,  profuse  night  sweat ; 
sweat  before  midnight;  sad;  apprehensive;  inclined 
to  weep," 

BROMINE   €ROTJF, 

**  Formation  of  pseudo  membrane  in  the  larynx  and 
trachea ;  spasm  in  the  larynx  occasioning  suffocation  ; 
cough  with  croup-sound,  hoarse,  wheezing,  fatiguing, 
not  permitting  one  to  utter  a  word  ;  accompanied  with 
sneezing ;  with  violent  suffocative  fits ;  respiration 
characterized  by  mucous  rattling ;  wheezing  ;  alter 
nately  slow  and  suffocative,  and  hurried  and  superfi 
cial  ;  laboured ;  painful ;  oppressed  ;  gasping  for  air  ; 
14 


314  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

heat  in  the  face  ;  increased  secretion  of  urine  ;  pulse 
rather  hard ;  slow  at  first,  afterwards  accelerated." 

CAUSTIC    AMMONIA    CROUP. 

"  Deep,  weak  voice  ;  fatiguing,  interrupted  speech  ; 
increased  secretion  of  mucus  in  the  bronchi ;  violent 
cough,  with  copious  expectoration  of  mucus,  especially 
after  drinking ;  difficult,  rattling,  laboured  breathing  ; 
stertorous  breathing  ;  suffocative  fits  ;  spasm  of  the 
chest." 

BICHROMATE    OF   POTASH    CROUP. 

"  Symptoms  approach  gradually  and  insidiously  ;  at 
first,  slight  difficulty  of  breathing  when  the  mouth  is 
closed  ;  slight  elevation  of  temperature  ;  pulse  irregu 
lar  and  intermittent,  or  frequent  and  small ;  as  the 
disease  progresses,  the  difficulty  of  breathing  increas 
es  ;  the  sound  of  the  air  as  it  passes  through  the 
trachea  is  shrill,  whistling,  as  if  it  passed  through  a 
metallic  tube  ;  voice  hoarse  ;  cough  not  frequent,  but 
hoarse,  dry,  barking,  and  metallic  ;  deglutition  painful ; 
tonsils  and  larynx  red,  swollen,  and  covered  with  an 
appearance  of  false  membrane  ;  after  a  time,  breath 
ing  affected  in  part  by  the  action  of  the  abdominal 
muscles,  and  those  of  the  neck  and  shoulder  blades ; 
head  inclined  backwards ;  breath  offensive  ;  finally, 
diminished  temperature  of  the  skin  ;  prostration ; 
stupor." 

The  medicines,  of  which  the  pathogeneti?  symptoms 
we  have  here  detailed,  are  those  which  are  most 
completely  specific  against  croup.  It  is  true  that  the 
other  articles  alluded  to,  as  aconite,  iodine,  belladonna, 
nux,  hyoscyamas,  sambucus,  tartar  emetic,  lachesis,  phos 
phorus,  drosera,  arsenicum,  &c.,  cover  many  of  the 
symptoms  usually  present,  especially  in  non-mem 
braneous  croup,  but  they  cannot  be  considered  posi 
tive  and  reliable  specifics  against  the  disease  fully  de 
veloped.  So  far,  however,  as  certain  special  indica 
tions  are  concerned,  these  medicines  may  often  be  em 
ployed  with  very  great  advantage, 

The  following  is  Dr.  Bosh's  method  of  treating 
croup  :  "  If  the  disease  begins,  as  it  frequently  does, 
with  an  inflammatory  fever,  then  I  give  first,  accord- 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  315 

ing  to  circumstances,  every  quarter  to  half  hour,  one 
to  two  drops  of  aconite  (the  dilution  second  or  third, 
depending  upon  the  age),  and  then  I  let  the  child  rest 
from  one  to  two  hours,  when  I  give  the  remedy,  which 
I  found  in  my  practice  to  be  the  main  remedy,  spongia, 
first,  second,  or  third  dilutions,  according  to  the  seve 
rity  of  the  disease  ;  eight  drops  in  four  ounces  of 
water,  of  this  every  quarter  to  half  hour,  or,  in  less  in 
tense  cases  only  every  hour,  half  a  table  spoonful.  If 
the  disease  has  proceeded  further,  and  paralytic  signs 
are  perceptible  (by  continued  obstruction  of  the  respi 
ration,  congestions  to  the  brain,  &c.),  then  I  give 
spongia  alternately  with  phosphorus.  If,  notwith 
standing  these  means,  the  disease  increases,  I  give 
spongia  in  alternation  with  tartar  stibiatus." 

Tartar  emetic  is  not  only  useful  in  the  early  stage  of 
croup,  but  it  is  also  indicated  when  there  are  signs  in 
dicative  of  partial  paralysis  of  the  pneumo-gastric 
nerve,  viz.,  face  livid  and  cold  ;  cold  sweat  on  the 
forehead  or  body  ;  respiration  exceedingly  difficult, 
short,  hoarse,  shrill,  or  whistling ;  head  thrown  back  ; 
pulse  small  and  rapid,  or  feeble  and  slow  ;  great 
weakness,  anxiety,  and  uneasiness  ;  difficulty  in  swal 
lowing  ;  short,  hoarse,  and  barking  cough ;  disposi 
tion  to  sleep.  The  remedy  should  be  given  in  the  first 
attenuation,  and  the  dose  repeated  every  twenty  or 
thirty  minutes,  until  relief  is  obtained. 

In  spasmodic  croup,  Dr.  Dunsford  relies  upon  aconite, 
hyoscyamus  and  belladonna. 

When,  in  addition  to  high  febrile  excitement,  the 
local  croupy  symptoms  are  urgent,  we  must  alter 
nate  the  proper  local  specific  with  aconite.  In  this 
way  we  may  often  give  spongia,  or  hcpar  sulph.  and 
aconite  advantageously  in  the  first  instance,  or  tartar 
emetic  and  aconite.  When  the  disease  obstinately  re 
sists  aconite,  spongia,  hepar  sulph.,  tartar  emetic,  both 
alone  and  in  alternation,  we  may  consult  phosphorus, 
lachesis,  sambucus,  senega  pol.,  &c. 

As  we  progress  in  the  knowledge  of  medicinal  sub 
stances,  a  still  greater  number  of  pure  specifics  will 
undoubtedly  be  added  to  our  Materia  Medica. 

Before  taking  leave  of  this  subject,  we  ask  attention 
particularly  to  the  employment  of  one  remedy  pre- 


316  DISEASES    OF    THE    RESPIRATOKY    ORGANS. 

viously  named,  for  the  cure  of  membraneous  croup. 
We  refer  to  the  nitrate  of  silver  as  a  direct  application 
to  the  affected  membrane.  For  some  years,  we  have 
been  in  the  habit  of  employing  a  strong  solution  of 
this  salt,  by  means  of  a  sponge  moistened  with  it 
and  introduced  into  the  larynx ;  and  in  several  in 
stances  the  most  satisfactory  results  have  followed. 
This  remedy  has  been  used  to  a  considerable  extent 
by  French  allopathists,  and  within  the  last  few  years 
by  a  number  of  American  physicians,  and  in  many 
cases  they  have  saved  life  when  every  other  means 
had  failed.  The  principle  on  which  it  cures,  how 
ever,  is  strictly  homoeopathic,  for  it  is  due  solely  to 
the  medicinal,  or  artificial  action  of  the  remedy,  that 
the  morbid  croupy  inflammation  is  superseded,  and  the 
false  membrane  gradually  destroyed  and  expelled. 

It  may  be  used  in  any  stage  of  true  croup,  and  will 
sometimes  succeed  in  effecting  a  cure  when  every  in 
ternal  remedy  has  failed. 

A  little  tact  will  enable  the  physician  to  apply  the 
solution  to  the  larynx,  or  trachea,  in  an  efficient  man 
ner,  and  with  perfect  safety.  For  minute  directions 
upon  the  subject,  the  reader  may  consult  "  Trousseau 
and  Belloc,"  and  Dr.  Green's  work  upon  Bronchitis, 
&c.,  published  in  New  York. 

Administration. — In  the  treatment  of  croup,  we 
generally  employ  the  lower  potencies.  In  regard  to 
the  repetition  of  doses,  no  definite  rules  can  be  given, 
but  the  practitioner  must  be  guided  by  the  variety  of 
the  disease,  the  severity  of  the  symptoms,  and  the 
effects  of  his  remedies. 

SECTION  III. 

A  CUTE     BRONCHITIS. 

This  complaint  is  of  most  frequent  occurrence  in  old 
age  and  in  childhood.  Its  seat  is  in  the  mucous  mem 
brane  of  the  bronchia,  but  authors  assure  us  that  the 
bronchial  inflammation  is  always  accompanied  with 
considerable  "  sanguineous  congestion  of  the  lungs," 
Effusion  into  the  substance  of  the  lungs,  is  peculiarly 
apt  to  occur  in  this  disease,  and  it  is  to  this  circum 
stance  that  its  danger  is  to  be  attributed. 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  317 

Diagnosis. — Constriction  and  aching  sensation,  ex 
tending  over  the  whole  chest ;  breathing  very  much 
oppressed,  quick,  anxious,  irregular,  laboured  ;  the 
voluntary  muscles  of  respiration  often  called  into 
play ;  expectoration  at  first  dry,  soon  becomes  viscid 
and  frothy,  and  sometimes  streaked  with  blood  ;  more 
or  less  cough,  hoarse  and  painful  in  children ; 
throbbing  pain  in  the  forehead  and  aching  pain  in  the 
eyes,  aggravated  on  coughing  ;  face  red  or  pallid  ; 
tongue  moist,  and  covered  with  a  white  fur  ;  bowels 
costive  ;  temperature  of  the  skin  nearly  natural,  but 
sometimes  hot  and  dry ;  pulse  at  first  but  little  in 
creased  in  frequency,  becoming,  as  the  disease  ad 
vances,  very  rapid  ;  urine  scanty  and  high  coloured  ; 
vertigo  ;  rattling  in  the  throat  and  chest ;  wheezing 
respiration.  As  the  malady  approaches  towards  a  fatal 
termination,  the  skin  becomes  suffused  with  a  cold  per 
spiration  ;  the  cheeks  and  lips  pale  and  livid ;  the  ex 
tremities  cold  ;  rattling  and  sense  of  suffocation  in  the 
throat ;  extreme  prostration  and  complete  insensi 
bility. 

The  peculiar  respiration  (the  mucous  rale  or  rattle 
of  Laennec)  which  is  so  apparent  in  bronchitis,  is  ow 
ing  to  the  "  passage  of  air  through  the  diseased  secre 
tion  of  the  air-passages,  and  may  be  heard  by  placing 
the  ear  to  the  chest,  long  before  it  becomes  so  severe 
as  to  be  distinguished  by  any  other  means.7' — Mclntosh. 

The  inflammation  in  bronchitis  is  of  a  much  more 
intense  character  than  that  which  is  present  in  catarrh 
or  influenza,  and  there  is  always  more  or  less  sanguin 
eous  congestion  of  the  lungs.  Many  of  the  more  ur 
gent  symptoms  of  the  complaint  are  due  to  this  last 
circumstance,  like  the  great  difficulty  of  breathing ; 
the  painful  sense  of  tightness  ;  stricture  and  oppres 
sion  in  the  chest ;  wheezing  respiration  ;  severe  cough  ; 
pallid  countenance  ;  vertigo  ;  pain  in  the  head,  &c. 
During  the  progress  of  this  disease,  the  substance  of 
the  lungs  often  becomes  hepatized. 

CHRONIC    BRONCHITIS. 

Chronic  bronchitis  is  at  the  present  time  an  exceed 
ingly  common  and  fashionable  disease.  From  the 
fact  of  its  occurring  for  the  most  part  in  clergymen, 


318  DISEASES    OF   THE   RESPIRATORY    ORGANS. 

lawyers,  and  other  public  speakers,  it  has  acquired 
" caste"  and  therefore,  it  may  be  that  every  slight  af 
fection  of  the  respiratory  apparatus  is  now  denomi 
nated  bronchitis.  It  occurs  at  all  periods  of  life,  and  in 
general,  is  insidious  in  its  approach,  though  it  occa 
sionally  succeeds  to  acute  bronchitis. 

When  the  disease  follows  an  acute  attack,  the  pa 
tient  will  be  left  with  some  cough  ;  expectoration  of 
viscid  or  puriform  sputa  ;  dyspnoea  on  the  slightest  ex 
ertion  ;  nocturnal  exacerbations  of  fever  ;  emaciation, 
and  in  some  instances  hectic  symptoms. 

The  stethoscope  usually  gives  us  the  sound  of  the 
crepitous  ronchus  at  certain  points,  and  now  and  then 
over  the  whole  chest,  while  at  the  same  time  the  re 
spiratory  murmur  may  often  be  heard. 

Those  cases  which  come  on  more  insidiously,  will 
be  often  found  complicated  with  chronic  laryngitis,  in 
dicated  by  hoarseness  of  the  voice  ;  raw  or  scraping 
sensation  in  the  larynx,  and  extending  over  the  chest ; 
copious  expectoration  of  opaque  or  purulent  sputa, 
which  affords  relief  to  the  patient ;  hoarse,  hollow,  and 
painful  cough  ;  increased  susceptibility  to  changes  of 
temperature  ;  night  sweats,  and  general  debility. 

When  the  expectoration  is  copious,  we  shall  have 
the  crepitous  ronchus,  either  at  isolated  points  or  over 
the  whole  chest ;  but  if  there  is  no  expectoration,  then 
the  sound  which  will  be  elicited  by  auscultation,  re 
sembles  snoring,  and  has  been  termed  "  dry  sonorous 
rattle ;"  or  in  some  instances,  the  " sibilous  rattle"  like 
the  chirping  of  birds.  Laennec  also  mentions  a  "  click 
ing"  sound,  which  he  compares  to  the  action  of  a  valve. 

Percussion  affords  us  no  aid  in  our  investigations  of 
bronchitis,  but  pressure  with  the  hand  upon  the  chest, 
will  often  enable  us  to  detect  the  mucous  rattle  with 
out  difficulty. 

Causes. — Protracted  exposure  to  cold  ;  alternations 
from  heat  to  cold  ;  inhalations  of  dust  and  other  irrita 
tive  substances  ;  insufficient  clothing,  and  improper 
exposure  of  the  throat  and  neck,  after  much  talking, 
public  speaking,  or  singing. 

We  believe  that  one  great  cause  of  the  very  fre 
quent  occurrence  of  chronic  bronchitis,  may  be 
found  in  the  reprehensible  fashion  of  shaving  the 
beard.  That  this  ornament  was  given  by  the  Creator 


DISEASES   OF  THE   RESPIRATORY    ORGANS.  319 

for  some  useful  purpose,  there  can  be  no  doubt,  for  in 
fashioning  the  human  body,  he  gave  nothing  unbecom 
ing  a  perfect  man,  nothing  useless,  nothing  superfluous. 
Hair  being  an  imperfect  conductor  of  caloric,  is  ad 
mirably  calculated  to  retain  the  animal  warmth  of 
that  part  of  the  body  which  is  so  constantly  and  ne 
cessarily  exposed  to  the  weather,  and  thus  to  protect 
this  important  portion  of  the  respiratory  passage  from 
the  injurious  effects  of  sudden  checks  of  perspiration. 

When  one  exercises  for  hours  his  vocal  organs,  with 
the  unremitted  activity  of  a  public  declamation,  the 
pores  of  the  skin,  in  the  vicinity  of  the  throat  and 
chest,  become  relaxed,  so  that  when  he  enters  the 
open  air,  the  whole  force  of  the  atmosphere  bears  upon 
these  parts,  and  he  sooner  or  later  contracts  a  bron 
chitis  ;  while,  had  he  the  flowing  beard  with  which 
his  Maker  has  endowed  him,  uncut,  to  protect  these 
important  parts,  he  would  escape  any  degree  of  ex 
posure  unharmed. 

The  fact  that  Jews  and  other  people  who  wear  the 
beard  long,  are  but  rarely  afflicted  with  bronchitis  and 
analogous  disorders,  suggests  a  powerful  argument  in 
support  of  these  views. 

Therapeutics. — The  medicines  most  worthy  of  con 
sideration  in  the  treatment  of  acute  and  chronic  bron 
chitis,  are,  aconite,  tartar  emetic,  belladonna,  bryonia, 
hepar  sulphur,  carbo  vegetabilis,  spongia,  ammonium 
carb.,  rhus  tox..  mercurius,  sulphur,  sambucus,  arseni- 
cum,  digitalis,  hyoscyamus,  pulsatilla. 

As  in  other  inflammatory  diseases,  aconite  is  also  in 
dicated  in  acute  bronchitis,  whenever  there  is  a  rapid 
and  full  pulse,  hot  skin,  and  other  symptoms  indicative 
of  a  high  state  of  febrile  excitement.  It  may  be  given 
at  the  second  or  third  potency,  and  repeated  every 
hour  until  a  decided  amendment  ensues. 

Tartar  emetic  is  indicated  when  there  are  severe 
paroxysms  of  coughing,  with  suffocating  obstruction 
of  respiration ;  wheezing  respiration ;  mucous  ron- 
chus ;  very  great  shortness  of  breath,  with  anxious 
oppression  at  the  chest ;  great  anxiety  and  agitation ; 
palpitation  of  the  heart ;  pain  in  the  back  and  loins  ; 
pressure  on  the  eyes ;  pains  in  the  head  ;  thirst. 

Administration. — A  grain  of  the  first  trituration  of 


320  DISEASES    OF   THE    RESPIRATORY    ORGANS 

tartar  emetic,  to  four  ounces  of  water — -a  tea  spoonful 
every  oner  two,  three,  or  four  hours,,  as  the  urgency  of 
the  symptoms  may  demand. 

In  cases  of  acute  bronchitis  in  which  the  predomin 
ant  symptoms  are,  oppression  and  weight  at  the  chest  ; 
short,  anxious  and  rapid  respiration ;  shaking,  spas 
modic  cough,  and  decided  cerebral  disturbance  from 
the  commencement,  belladonna  is-  our  most  valuable 
remedy. 

Administration. — Like  that  of  aconite. 
The  indications  which  point  to  bryonia,  are,  nead- 
ache  aggravated  by  movement ;  pressure  in  the  eyes  ; 
dryness  in  the  throat ;  respiration  difficult,  short,  and 
anxious  ;•  pressure  on  the  chest  as  if  from  a  weight  ? 
stingings  in  the  chest ;  cough  with  stingings  in  the 
chest,  or  with  severe  aching  pains  in  the  head.  In  the 
acute  attacks  of  children,  with  suffocative  cough,  very 
great  oppression  at  the  chest,  exceedingly  difficulty 
rapid,  and  anxious  or  sighing  respiration,  loud  mu- 
eous  ronchus,  rapid  pulse,  hot  skin,  thirst,  great 
agitation  and  anxiety?  this  remedy  is  also  especially 
called  for. 

It  may  be  exhibited  at  the  first  to  the  sixth  potency, 
and  frequently  repeated  until  the  disease  subsides. 
The  practitioner  may  sometimes  alternate  it  with 
aconite,  with  benefit.  Pulsatilla  is  indicated  in  bron 
chitis  when  the  cough  is  dry  in  the  first  part  of  the 
complaint,  but  soon  becomes  moist,  "  with  easy  ex 
pectoration  of  abundant  yellow  and  bitter,  or  saline 
and  disgusting  matter ;  sometimes  with  nausea  or 
retching,  or  a  sensation  of  reversion  in  the  stomach,  as 
if  about  to  vomit.  The  cough  occurs  principally  at 
night,  on  lying  down ;  proceeds  from  a  tickling  or 
itching  in  the  larynx,  or  by  scraping  and  dryness  in 
the  trachea,  accompanied  with  fatiguing  pains  in  the 
abdomen,  and  stitches  in  the  back,  shoulders,  sides,  or 
chest,  and  relieved  on  rising  up  in  bed." — (Croserio). 
It  may  be  given  in  the  same  manner  as  bryonia. 

In  chronic  bronchitis,  characterized  by  anxious, 
hoarse,  and  wheezing  respiration,  much  aggravated 
on  lying  down  ;  attacks  of  suffocation,  which  force  the 
patient  to  throw  the  head  back,  in  order  to  take 
breath ;  dyspnoea ;  dry,  rough,  and  hollow  cough ; 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  321 

cough,  with  expectoration  of  mucus ;  hoarseness  of 
voice  ;  exacerbations  of  fever  in  the  after  part  of  the 
day,  succeeded  by  night  sweats,  hepar  sulph.  is  an 
important  specific.  In  cases  which  seem  to  have  been 
connected  with  suppression  of  salt  rheum,  or  other 
eruptive  disease,  or  metastases  of  arthritic  inflamma 
tions,  this  remedy  should  always  be  borne  in  mind. 
It  is  also  useful  in  those  cases  which  threaten  to 
terminate  in  tubercular  consumption. 

The  third  trituration  may  be  used  :  a  dose  from 
two  to  four  times  in  twenty-four  hours. 

When  bronchitis  is  complicated  with  angina  trache- 
alis,  we  may  resort  to  spongia  tosta  with  confidence, 
either  alone  or  in  alternation  with  hepar  sulph.  If 
febrile  symptoms  run  high,  these  remedies  should  be 
preceded  by  aconite. 

When  suffocation  is  threatened  from  loss  of  tone 
and  power  .of  the  respiratory  organs,  rendering  them 
incapable  of  expelling  the  morbid  secretions  which 
obstruct  the  free  entrance  of  air  into  the  pulmonary 
structure,  ammonium  carb.,  rhus  tox.,  sambucus,  arseni- 
cum,  digitalis,  hyoscyamus,  and  stannum,  are  worthy  of 
careful  examination.  In  making  our  selection  from 
these  medicines,  regard  should  not  only  be  had  to  the 
actual  symptoms  present,  but  to  the  temperament, 
hereditary  predisposition,  and  the  remote  cause  of  the 
malady.  For  example,  if  in  any  given  case  the  in 
dications  actually  present,  point  equally  to  hepar 
sulph.  and  rhus  tox.,  but  the  attack  was  found  to  be 
connected  with  a  repelled  eruption,  our  choice  would 
evidently  rest  upon  the  former  medicine  ;  while  if 
the  disease  was  found  to  be  dependent  upon  an 
arthritic  habit,  rhus  would  be  the  appropriate  re 
medy. 

In  the  last  stages  of  acute  bronchitis,  when  there  is 
danger  that  the  malady  will  run  into  the  chronic 
form,  sulphur  has  been  highly  lauded  by  many  emi 
nent  practitioners.  If  the  disease  occurs  in  persons  of 
lymphatic  constitutions,  and  subject  to  eruptions, 
swelling  of  the  glands,  &c.,  this  remedy  can  scarcely 
be  dispensed  with  during  the  progress  of  the  attack. 

For  the  profuse  and  debilitating  sweats  which  now 
and  then  occur  during  the  continuance  of  the  symp- 

14* 


322  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

toms,  valuable  specifics  will  be  found  in  mercurius, 
acid  nit.,  and  acid  phos.  Many  physicians  have  com 
mended  carbo  veg.  in  the  strongest  terms,  in  chronic 
bronchitis,  and  it  has  doubtless  effected  many  excel 
lent  cures.  It  may  be  used  at  the  third  attenuation, 
one  grain  once  or  twice  daily. 

SECTION    IV. 

PNEUMONIA. LUNG    FEVER. 

Diagnosis. — The  symptoms  of  lung  fever  vary  so 
much  in  different  cases,  that  an  exact  portrait,  which 
shall  be  recognisable  in  all  instances,  can  hardly  be 
given.  The  signs,  however,  which  are  more  particu 
larly  characteristic,  may  be  enumerated  as  follows : 
dull  or  deep-seated  pain,  or  a  tightness  in  the  chest ; 
frequent  short  cough,  with  expectoration  of  a  viscid, 
tenacious  matter,  of  a  yellow,  green,  or  pale  colour, 
sometimes  tinged  with  blood ;  rapid  and  difficult 
respiration  ;  inclination  for  the  most  part  to  lie  upon 
the  affected  side,  or  the  back  ;  great  heat  of  the  skin  ; 
headache  ;  thirst ;  rapid  and  full  pulse  (though  this 
last  symptom  is  by  no  means  uniformly  present,  as 
the  disease  sometimes  runs  on  to  a  fatal*  termination 
without  any  material  change  in  the  pulse)  ;  general 
restlessness ;  urine  scanty,  very  red,  and  sometimes 
scalding.  The  character  of  the  expectoration  during 
the  first  stage  of  the  malady  is  supposed  by  many  to 
afford  a  characteristic  mark  of  the  malady  ;  and  it  is 
from  this  circumstance  that  Laennec  has  denominated 
the  sputa  expectorated,  pneumonic,  or  glutinous. 
During  the  stage  of  hepatization,  the  sputa  diminish 
in  quantity,  become  lighter  in  colour,  and  less  trans 
parent,  until  finally,  when  the  third  stage  supervenes, 
expectoration  of  almost  a  mucous  character  occurs. 

Sometimes  pneumonia  is  complicated  by  more  or 
less  derangement  of  the  biliary  organs,  when  we  shall 
have  superadded  to  the  lung  affection  the  symptoms 
indicative  of  such  derangement.  This  variety  of  the 
complaint  is  termed  bilious  pneumonia. 

M.  Saucerotte  recognises  a  kind  of  latent  pneumo 
nia,  depending  upon  a  certain  peculiarity  of  constitu 
tion,  entirely  unlike  ordinary  pneumonia,  and  which 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  323 

seems  to  commence  by  the  second  stage,  or  that  of 
hepatization.  His  description  of  the  disease  is  as 
follows  :  First,  "  Premonitory  symptoms,  either  entirely 
absent,  or  of  slight  importance,  consisting  of  lassitude, 
with  shivering,  loss  of  appetite,  and  but  little  fever." 

Second,  "Symptoms.  The  temperature  of  the  skin  is 
not  sensibly  augmented  ;  the  pungent  heat  of  ordi 
nary  pneumonia  seldom  present ;  pulse  usually  but 
little  affected  ;  respiration  natural,  and  no  pain  in  the 
chest.  Percussion  always  elicits  a  dull  sound  over  a 
considerable  extent,  and  bronchial  respiration  is 
audible  over  the  same  locality.  In  some  cases,  slight 
crepitation  may  be  heard  around  the  hepatized  spot." 

Third.  "  Progress  and  duration  variable.  In  some 
cases  we  have  seen  the  disease  linger  for  six  or  seven 
weeks.  When  the  case  terminates  favourably,  the 
dulness  gradually  disappears,  and  the  bronchial 
souffle  is  replaced  by  crepitation ;  respiration  be 
comes  more  free,  and  the  general  aspect  of  the  patient 
improves. 

Fourth.  "  Diagnosis. — Pleurisy  is  the  affection  with 
which  latent  pneumonia  is  apt  to  be  confounded.  In 
chronic  pleurisy,  however,  there  is  more  constantly  a 
pain  in  the  side,  and  the  region  of  the  dulness  varies 
with  the  position  of  the  patient,  Apoplexy,  and  the 
bulging  of  the  intercostal  spaces,  shortly  clear  up  the 
diagnosis.  The  history  of  the  case  distinguishes  it 
from  phthisis. 

Fifth.  "  Causes. — For  the  most  part,  exposure  to 
cold." 

Although  Dr.  Saucerotte  is  a  practitioner  of  the  old 
school,  his  sole  internal  remedy  in  this  affection  is 
tartar  emetic,  our  own  specific  in  similar  cases. 

Viewed  anatomically,  inflammation  of  the  substance 
of  the  lungs  presents,  according  to  Laennec,  three  dif 
ferent  degrees,  or  stages,  which  he  designates,  first, 
engorgement,  or  congestion  ;  second,  hepatization  ; 
third,  purulent  infiltration. 

In  the  first  degree,  the  lung  loses  in  a  measure  its 
crepitous  feel,  is  of  a  livid  colour,  and  more  solid  than 
natural. 

In  the  second  degree,  the  lung  presents  the  appear 
ance  of  liver ;  it  is  not  crepitous,  is  heavier  than  in 


324  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

the  first  degree,  and  shows  a  granular  appearance  when 
cut  into,  or  torn  asunder.  Laennec,  Andral,  and  Louis, 
suppose  this  hepatization  to  be  owing  to  the  con 
version  of  the  air-cells  into  solid  grains,  by  the  hard 
ening  of  a  concrete  fluid,  which  is  poured  out  during 
the  inflammation ;  while  Dr.  Williams  supposes  that 
*'  these  granulations  contain  no  viscid  mucus,  but  con 
sist  of  little  bunches  of  vesicles,  which  have  been  ob 
literated  by  the  swelling  of  their  membranous  tunics, 
and  the  enlargement  of  their  blood  vessels." 

In  the  third  degree,  the  external  appearance  of  the 
lung  is  similar  to  that  of  the  second  degree,  but  of  a 
lighter  colour.  The  same  heavy,  hard,  and  granular 
character  obtains,  but  when  the  lung  is  cut  into,  a 
yellowish  and  purulent  matter  makes  its  appearance. 
*As  the  disease  advances,  the  granular  condition  dis 
appears,  and  purulent  abscesses  take  its  place. 

The  phenomena  elicited  by  auscultation  and  per 
cussion,  during  the  stage  of  engorgement,  are  the  ere- 
pitous  rhonchus,  the  respiratory  sound  being  yet  audible, 
and  the  ordinary  healthy  sound  on  percussion. 

As  soon  as  hepatization  has  occurred,  percussion 
over  the  affected  part  yields  a  dull  sound,  and  neithjer 
the  respiratory  murmur  nor  the  ere  pitous  rhonchus 
can  longer  be  heard.  There  are  certain  other  sounds, 
like  bronchophony,  a  kind  of  blowing,  &c.,  which 
may  exist  in  certain  cases  of  hepatization,  but  these 
signs  are  so  vague  and  uncertain,  that  immense  prac 
tice  is  requisite  to  enable  the  physician  to  form  an 
accurate  judgment  respecting  them. 

After  the  third  stage  has  existed  a  little  time,  and 
the  pus  begins  to  soften,  the  mucous  rhonchus  may 
be  heard  in  the  bronchi.  In  some  instances  the  pus  is 
not  expectorated  or  absorbed,  but  forms  an  abscess  in 
some  part  of  the  pulmonary  tissue.  We  shall  then 
Irnve  a  mucous  rhonchus  over  the  sea.t  of  the  abscess, 
also  pectoriloquy,  and  what,  is  termed  a  *'  bronchial 
or  cavernous  cough/' 

When  the  disease  terminates  favourably,  and  reso 
lution  takes  place,  it  will  be  found  that  the  lungs 
gradually  and  by  successive  degrees,  return  to  their 
original  state,  as  is  indicated  by  the  diminution  of  the 
erepitons  rhonehns,  and  the  return  of  the  natural  re* 


DISEASES    OF   THE    RESPIRATORY   ORGANS.  325 

spiratory  sound,  when  the  inflammation  had  ceased  at 
the  first  stage  ;  also  by  the  reappearance  of  the  cre- 
pitous  rhonchus,  &c.,  when  the  malady  had  progressed 
to  the  second  and  third  stages. 

Causes. — Lung  fever  is  a  disease  peculiar  to  tem 
perate  and  cold  latitudes,  and  usually  occurs  during 
the  winter  months.  The  usual  causes  are,  undue  ex 
posure  to  intense  cold,  sudden  suppression  of  perspira 
tion,  epidemic  influences,  and  the  inhalation  of  noxious 
vapours  or  gases.  Laennec  and  Forbes  assert  that 
pneumonia  is  sometimes  induced  by  the  bite  of  the  rat 
tle  snake,  (crotalus  horridus,)  and  of  other  venomous 
serpents ;  and  that  it  may  also  arise  from  the  "  injec 
tion  of  various  medicinal  substances  into  the  veins." 
These  assertions  go  far  to  prove  a  specific  operation  of 
these  substances  upon  the  respiratory  organs,  and  may 
afford  a  valuable  hint  respecting  their  homoeopathic 
application  in  pneumonia. 

Therapeutics. — The  prominent  medicines  for  the 
treatment  of  pneumonia,  are,  aconite,  bryonia,  bella 
donna,  tartar  emetic,  phosphorus,  ipecacuanha,  sambucus, 
sulphur,  lachesis,  rlius  tox.,  arsenicum,  mercurius,  acid 
phosphoric,  arnica. 

In  the  first  stage  of  the  disease,  when  symptoms  in 
dicative  of  a  high  grade  of  febrile  excitement  are  pres 
ent,  as  hot  and  dry  skin,  great  thirst,  rapid  and  hard 
pulse,  scanty  and  high  coloured  urine,  &c.,  aconite  and 
belladonna  may  be  given  in  alternation,  until  the  in 
flammatory  symptoms  subside.  These  remedies  are 
often  alone  sufficient  to  break  up  the  disease  in  this 
stage  ;  and  even  when  they  fail  of  effecting  a  complete 
cure,  they  generally  moderate  most  essentially  the 
lever,  and  mitigate  all  the  other  symptoms. 

If,  after  the  subsidence  of  these  symptoms,  stitches 
in  the  side,  difficult  and  anxious  respiration,  find  trou 
blesome  cough  continue  to  harass  the  patient,  re 
course  must  be  had  to  bryonia. 

When,  however,  the  second  stage,  or  hepatization 
has  occurred,  indicated  by  dull  sound  on  percussion, 
bronchial  respiration,  &c.,  we  should  at  once  have  re 
course  to  tartar  emetic  or  phosphorus. 

The  external  indications  which  point  to  the  use  of 
emetic  tartar,  flre,  dull  sound  on  percussion  :  absence  of 


326  DISEASES    OF   THI    RESPIRATORY    ORGANS. 

the  respiratory  murmur,  or  bronchophony  ;  skin  cold, 
and  covered  with  a  clammy  sweat ;  considerable  ex 
pectoration  of  a  yellowish  or  brownish  colour,  and 
mixed  with  blood  ;  pulse  small,  soft  and  frequent  ; 
tongue  covered  with  a  dry  and  dark  fur,  and  perhaps 
red  at  the  edges. 

Physical  sensations. — "  Great  oppression  and  diffi 
culty  of  breathing ;  cough  loose,  and  accompanied 
with  rattling  of  mucus  ;" — (Midler) — burning  under 
the  sternum,  and  sometimes  as  high  up  as  the  throat ; 
sensation  as  if  the  chest  were  lined  with  velvet ;  want 
of  air  and  want  of  breath  previous  to  the  paroxysms 
of  coughing  ;  also  pneumonia  biliosa,  with  gastric  and 
bilious  symptoms,  as  yellow  tinge  of  skin  ;  yellow  or 
brownish  fur  upon  the  tongue  ;  bitter  taste  ;  nausea 
and  bilious  vomiting ;  yellow  or  dark  urine  ;  headache ; 
general  sensation  of  lassitude  and  debility. 

Mental  and  moral  symptoms. — Anxiety  ;  restlessness ; 
confusion  of  ideas;  sometimes  furious  delirium. 

Administration. — A  grain  of  tartar  emetic  to  six 
ounces  of  pure  water — a  teaspoonful  every  one,  two, 
three  or  four  hours  as  required. 

Phosphorus  has  been  highly  extolled  also  in  the 
second  stage  of  pneumonia,  and  in  certain  cases  of 
pleuro-pneumonia,  where  aconite  and  bryonia  have 
lailed  in  effecting  a  cure.  Dr.  Fleischmann  has  used  it 
successfully  in  all  stages  of  lung  fever. 

Buchner,  Griesselich,  Homer,  Bosch,  and  Shellham- 
mer,  have  employed  it  with  advantage  when  the  third 
stage  had  set  in  with  great  prostration,  livid  or  hip- 
pocratic  countenance,  sunken  eyes,  cold,  viscid  sweats, 
tremulous  and  feeble  pulse,  dry  and  dark  lips  and 
tongue,  difficult  expectoration  of  a  brown  or  rust 
colour, extreme  anguish,  subsultus  tendinum,  muttering 
or  furious  delirium,  with  grasping  at  flocks,  sense  of 
suffocation,  and  involuntary  stools. 

Miiller  describes  the  special  pathogenetic  symp 
toms  of  phosphorus,  having  reference  to  pneumonia, 
as  follows :  "  Sticking  and  violent  stitches  in  various 
parts  of  the  chest,  left  and  right  side,  sometimes  ac 
companied  with  burning,  in  rest  and  during  motion, 
especially  when  sitting  and  taking  an  inspiration ; 
pain  in  the  chest,  especially  during  an  inspiration  ; 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  3S7 

itching  in  the  interior  of  the  chest,  with  dry  cough  ; 
feeling  of  heaviness  in  the  chest ;  anxiety  in  the 
chest,  with  arrest  of  breathing,  and  beating  in  the 
right  side  of  the  chest ;  great  oppression  of  breathing  ; 
great  shortness  of  breath  ;  oppressive  tightness,  and 
tensive  sensation  in  the  chest,  as  if  a  band  were  en 
circling  it ;  tension  and  dryness  in  the  chest ;  con- 
strictive  clawing  and  pressing  in  the  upper  part  of 
the  chest ;  loud,  rattling  breathing  ;  dry,  hollow  cough, 
without  expectoration  ;  a  sort  of  hacking  cough,  with 
huskiness  of  the  chest,  and  expectoration  of  some 
mucus ;  cough,  with  expectoration  of  transparent 
mucus,  accompanied  with  tensive  pain,  and  after 
wards  with  sticking  pain  in  the  chest;  fatiguing 
cough,  with  white,  tenacious  expectoration  ;  the  ex 
pectorated  mucus  is  streaked  with  blood  ;  bloody  ex 
pectoration,  with  mucus,  accompanied  with  short, 
slight  cough ;  coughing  up  small  clots  of  pus,  with 
smarting  burning  behind  the  sternum ;  sticking  pain 
in  the  pit  of  the  stomach  when  coughing,  compelling 
one  to  lay  the  hand  upon  the  pit ;  short  breath  after 
every  turn  of  cough." 

From  the  above  it  will  be  seen  that  phosphorus  in 
cludes  a  greater  range  of  symptoms  than  tartar  emetic. 
In  typhoid  pneumonia,  especially,  it  is  often  of  distin 
guished  service  where  hepatization  has  occurred,  and 
the  symptoms  point  to  the  third  stage. 

Administration. — It  may  be  employed  at  the  first, 
second,  or  third  attenuation,  and  the  dose  repeated 
according  to  circumstances. 

In  typhoid  pneumonia,  as  well  as  in  cases  attended 
from  the  first  with  great  debility  and  prostration  of 
the  energies  of  the  system,  rhus  tox.  will  be  found  a 
remedy  of  much  efficiency,  either  alone,  or  in  alterna 
tion  with  some  other  specific.  Should  the  case  be 
complicated  with  pains  in  the  chest  or  side,  of  a  rheu 
matic  character,  rhus  rad.  may  occasionally  be  em 
ployed  with  advantage.  This  medicine  is  usually 
given  after  aconite  and  bryonia. 

Sulphur  is  an  important  remedy  in  certain  pro 
tracted  cases  of  pneumonia  occurring  in"  psoric  or 
scrofulous  subjects,  and  which  threaten  to  terminate 
in  phthisis.  Indeed,  in  most  of  those  cases  of  chronic 


328  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

pneumonia  which  seem  to  have  arrived  at  a  fixed 
point,  the  patient  neither  improving  nor  apparently  re 
trograding,  we  should  always  bear  in  mind  this  pow 
erful  antipsoric. 

When  the  disease  has  reduced  the  patient,  notwith 
standing  our  remedies,  to  a  state  of  extreme  prostra 
tion,  with  very  short  breath  on  the  slightest  exertion, 
dry  and  dark  tongue  and  lips,  extreme  anguish,  stitches 
in  the  side,  great  thirst,  diarrhoea,  ringing  and  buzzing 
in  the  ears,  arsenicum  is  the  proper  remedy.  In  ex 
amples  of  this  description,  the  remedy  should  be  fre 
quently  repeated  until  a  decided  impression  is  pro 
duced. 

If  the  pulmonary  inflammation  threatens  to  run 
into  gangrene,  as  will  be  indicated  by  fetid  and  green 
ish,  or  dark  expectoration,  arsenicum  is  appropriate, 
as  are  also  sometimes  carbo  veg.  and  china. 

Pneumonia  occurring  in  old  and  feeble  persons,  and 
attended  with  symptoms  showing  a  low  grade  of  in 
flammatory  action,  will  require  the  use  of  phosphorus, 
ipecacuanha,  sambucus,  verairum,  mix  vom.,  china,  bel 
ladonna,  lachesis,  lycopodium,  and  cantharis. 

Arnica  is  applicable  in  pulmonary  inflammations 
proceeding  from  mechanical  injuries. 

The  symptoms  of  pneumonia  and  bronchitis  com 
bined,  will  be  covered  by  tartar  emetic,  aconite,  mercu- 
rius,  phosphorus,  capsicum,  bryonia,  carbo  veg.,pulsatilla, 
senega,  and  nux  vom. 

We  usually  select  one  of  the  low  attenuations,  and 
repeat  the  dose  once  in  two,  three,  or  four  hours,  until 
a  marked  impression  is  produced  upon  the  symptoms. 

SECTION  V. 

PLEURITIS. PLEURISY. 

Diagnosis. — This  malady  commences  with  lassitude, 
chills,  and  other  febrile  symptoms,  succeeded  in  a 
short  time  by  the  following  local  phenomena :  "  The 
stitch,  dyspnoea,  cough,  and  recumbency  on  the  af 
fected  side/' — Laennec.  Dr.  Wurm,  of  Vienna,  main 
tains,  however,  that  "  the  posture  of  the  patient  is 
usually  upon  the  back."  The  inspirations  are  short, 
iMpid,  arid  attended  with  severe  sharp  stitches,  unless 


DISEASES    OP    THE    RESPIRATORY    ORGANS.  329 

the  inflammation  be  very  slight,  in  which  case,  but 
little  alteration  will  be  observed  in  the  breathing ; 
there  is  often  experienced  a  sense  of  tightness  and 
oppression  at  the  chest;  there  is  generally  little  or  no 
cough  unless  the  lungs  or  the  bronchia  are  involved, 
when  there  occurs  a  short  and  dry  cough,  with  but  a 
small  quantity  of  glairy  expectoration,  and  very  pain 
ful  ;  the  pulse  is  rapid  and  full ;  skin  hot  and  dry  ; 
urine  scanty,  and  of  a  deep  red  or  dark  colour ;  the 
pain  is  almost  invariably  confined  to  one  side  of  the 
chest,  and  increased  by  inspiration,  coughing,  and 
movement ;  urgent  thirst ;  great  dyspnoea  ;  constant 
inclination  to  lie  upon  the  affected  side  or  back  ;  ab 
dominal  respiration,  and  pain  in  the  intercostal  spaces 
on  pressure.  These  symptoms  are  speedily  succeeded 
by  others,  which  indicate  that  effusion  has  taken  place. 
Laennec,  Johnson,  and  Mackintosh  believe  that  effu 
sion  commences  as  soon  as  the  inflammation  is  estab 
lished  ;  while  others,  equally  eminent,  contend  that  a 
considerable  period  elapses  before  it  occurs.  But  the 
weight  of  testimony  seems  to  be  in  favour  of  the  opin 
ion  of  the  former  gentlemen.  Amongst  the  signs 
which  are  characteristic  of  pleurisy  with  effusion, are, 
increased  size  of  the  affected  part  of  the  chest,  appa 
rent  to  the  eye,  or  by  mensuration  ;  also  aegophony, 
perceptible  by  the  stethoscope  from  the  commence 
ment  of  the  inflammation,  or  after  a  moderate  quan 
tity  of  fluid  has  been  effused,  disappearing  when  the 
effusion  becomes  very  large  in  quantity,  and  re-ap 
pearing  as  absorption  takes  place,  and  the  liquid  di 
minishes  ;  dull  sound  on  percussion,  and  failure  of  the 
respiratory  murmur  in  the  affected  side. 

Should  the  lungs  happen  to  be  involved,  the  sputa 
will  be  tinged  or  streaked  with  blood,  and  more  co 
pious  than  in  simple  pleuritis.  Other  symptoms  will 
also  obtain  which  characterize  pleuro-pneumonia. 

The  effusion  in  pleurisy  may  be  either  of  a  plastic, 
serous,  or  haemorrhagic  character.  The  severity  of 
the  febrile,  and  other  symptoms,  will  depend  upon  the 
rapidity  of  the  effusion,  and  its  quality  and  quantity. 

Causes. — Atmospheric  vicissitudes,  sudden  checking 
of  the  perspiration,  metastases  of  rheumatism,  erysi 
pelas,  gout,  &c.,  mechanical  injuries,  surgical  opera- 


330  DISEASES    OP    THE    RESPIRATORY    ORGANS. 

tions  upon  cancerous  and  scrofulous  parts.  We  have 
witnessed  two  cases  of  pleurisy  which  supervened  as 
a  consequence  of  surgical  operations.  One  of  these 
cases  occurred  after  amputation  of  the  thigh  for  a 
malignant  disease  of  the  leg,  and  proved  speedily 
fatal.  The  other  case  came  on  about  two  weeks 
after  excising  a  large  fungous  tumour  from  the  breast 
of  a  female,  which  also  proved  fatal.  Both  of  these 
cases  were  unusually  violent,  and  ran  their  course 
with  very  great  rapidity.  It  is  worthy  of  remark,  that 
in  both,  the  wounds  by  the  operation  were  progressing 
as  favourably  as  usual.  Whether  pleurisy,  in  these 
instances,  is  attributable,  as  some  writers  suppose,  to 
the  absorption  of  pus  into  the  system,  or  to  some  other 
cause,  we  are  at  a  loss  to  determine  ;  but  that  the 
disease  is  peculiarly  violent  and  fatal,  has  been  ob 
served  by  all  who  have  witnessed  its  occurrence. 

Therapeutics. — The  most  valuable  remedies  in  the 
treatment  of  pleurisy,  are,  aconite,  bryonia,  tartar 
emetic,  phosphorus,  arsenicum,  rhus  tox.,  and  arnica. 
During  the  progress  of  the  disorder,  we  should  also 
bear  in  mind  sulphur,  scillae,rhus  rad.,  lachesis,  silicea, 
and  china. 

Aconite  is  eminently  appropriate,  either  alone  or  in 
alternation  with  other  specifics,  whenever  the  inflam 
matory  action  runs  high,  accompanied  with  hot  skin, 
quick  and  full  pulse,  urgent  thirst,  and  general  sus 
pension  of  the  secretory  functions.  Wurm  and  Trinks 
commend  it  in  the  highest  terms  in  that  variety  of 
pleuritis  which  is  characterized  by  the  plastic  nature 
of  the  effusion,  and  the  severity  of  its  inflammatory 
fever.  It  should  be  exhibited  at  the  very  commence 
ment  of  the  disease,  and  in  the  lowest  potencies,  and 
repeated,  in  urgent  cases,  every  hour  until  the  fever 
subsides. 

Bryonia  is  a  specific  of  great  value  in  the  malady 
under  consideration,  and  the  power  which  it  possesses 
of  promptly  controlling  and  subduing  the  most  violent 
cases  of  pleurisy,  is  a  matter  of  astonishment  to  us, 
who  formerly  believed  copious  and  repeated  venesec 
tions  to  be  the  only  safe  means  of  effecting  a  cure. 
We  have  treated  a  great  number  of  cases,  in  which 
bryonia  has  been  our  chief  remedy,  and  we  have  not 


DISEASES    OP   THE    RESPIRATORY    ORGANS.  331 

failed  in  a  single  case,  but  our  cures  have  been  far 
more  prompt,  pleasant,  and  satisfactory,  than  we  ever 
effected  under  the  old  treatment.  The  effusion  has 
invariably  been  more  speedily  absorbed,  and  the  pleura 
arid  lungs,  as  well  as  the  system  at  large,  have  more 
perfectly  recovered  their  original  tone  and  vigour, 
than  in  cases  which  have  been  treated  by  the  old 
method.  Nor  will  this  appear  at  all  strange,  when  it 
is  remembered,  that  by  one  method,  the  structure  ac 
tually  diseased  is  alone  acted  upon,  while  by  the  other, 
the  whole  organism  is  subjected  to  the  influence  of  the 
most  powerful  medicines,  impairing  the  integrity  and 
vigour  of  almost  every  part,  without  producing  any 
certain  or  decided  effect  upon  the  pleura,  or  any  other 
pulmonary  tissue. 

Let  the  sceptical  allopath  prove  upon  his  own  per 
son  in  health,  the  pure  effects  of  bryonia,  tartar  emetic, 
phosphorus,  lachesis,  scillce,  &c.,  upon  the  respiratory 
organs,  and  then  test  them  judiciously  in  cases  of  dis 
ease  after  the  homoeopathic  principle,  similia  similibus, 
and  he  will  forever  abandon  the  uncertainties  and 
dangers  of  the  lancet,  mercurials,  counter-irritations, 
&c. 

Bryonia  may  follow  or  alternate  with  aconite, 
advantageously.  The  external  indications  are,  cheeks 
flushed  and  hot,  dry  or  moist  ;  respirations  short  and 
rapid,  and  performed  principally  with  the  abdominal 
muscles  ;  position  upon  the  affected  side  ;  pulse  quick 
and  full ;  tongue  dry  ;  breath  hot ;  urine  scanty,  and 
red  or  dark  ;  dull  sound  on  percussion  of  the  affected 
side  ;  respiratory  murmur  indistinct  or  entirely  want 
ing. 

Physical  sensations. — Stinging,  shooting,  or  burning 
pains  in  the  side,  aggravated  on  inspiration,  coughing, 
on  rnpvement ;  respiration  difficult,  short,  anxious,  and 
rapid  ;  sense  of  tightness  ;  a  weight  or  oppression  at 
the,  chest ;  painful  cough,  dry  or  with  expectoration  of 
a  glairy  sputa,  sometimes  tinged  with  blood  ;  great 
heat  of  skin,  alternating  with  frequent  coldness  and 
shivering  ;  urgent  thirst ;  pain  in  the  intercostal  spaces 
on  pressure ;  weariness  and  inclination  to  retain  the 
recumbent  position. 


332  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

Mental  and  moral  symptoms. — Anxious,  apprehensive, 
desponding  ;  fear ;  irritability  ;  peevishness  ;  restless 
ness. 

Administration. — A  dose  of  the  first  dilution  every 
hour,  alone  or  in  alternation  with  aconite,,  until  the 
pain,  difficulty  of  breathing,  &c.,  are  relieved. 

Tartar  emetic. — According  to  Majendie,  this  medi 
cine  possesses  the  specific  power  of  causing  engorge 
ment  and  inflammation  of  the  lungs  when  given  in 
large  doses.  There  can  be  no  doubt  that  it  is  an  ab 
solute  and  decided  specific  over  the  respiratory  organs 
as  well  as  the  gastro-intestinal  membrane.  This  has 
been  demonstrated  by  Cloquit,  Miiller,  Majendie, 
Gross,  and  others,  by  autopsicai  examinations,  and  by 
numerous  provings  upon  persons  in  health. 

It  is  a  common  remedy  with  the  old  school,  in  affec 
tions  of  the  respiratory  organs  ;  yet  they  are  entirely 
ignorant  of  its  curative  action.  It  is  only  necessary 
to  refer  to  the  unsatisfactory  and  contradictory  opinions 
of  Laennec,  Rasori,  Broussais,  Eberle,  Payne,  Blake, 
and  Barbier,  upon  this  subject,  to  be  convinced  of  the 
utter  want  of  accurate  knowledge  and  uncertainty  of 
principle  amongst  allopathists  in  the  administration  of 
medicines. 

The  homoeopathist,  on  the  contrary,  demonstrates  by 
numerous  provings  in  health,  that  it  exerts  a  specific 
force  upon  the  lungs  and  their  appendages,  and  he 
therefore  gives  it  in  inflammations  of  these  organs 
with  confidence  and  success.  With  him  there  is  no 
random  and  crude  speculation — no  breaking  down  of 
the  organism  by  violence,  hoping  in  the  general  ruin 
to  cruhh  the  malady,  but  having  a  definite  object,  and 
seeing  his  goal,  he  quietly,  safely,  and  surely  attains  it. 

The  external  indications  for  tartar  emetic,  are  :  face 
flushed,  hot  and  dry,  or  pale,  wan  and  anxious,  and 
covered  with  sweat ;  respirations  short  and  obstructed  ; 
surface  burning  hot  and  dry,  or  cold  and  bathed  with 
cold  perspiration  ;  pulse  quick,  weak,  or  full ;  tongue 
moist  and  clean,  or  loaded  with  a  white  or  brown  fur  ; 
urine  scalding  hot,  red  or  brown  ;  mucous  or  bloody 
expectoration  ;  general  appearance  indicative  of  great 
anxiety  and  physical  prostration. 

Physical  sensations. — Respiration  short,  difficult,  ob- 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  333 

structed,  and  attended  with  stinging  or  shooting  pains  ; 
cough  with  expectoration  of  mucus,  sometimes  ting 
ed  with  blood  ;  violent  throbbing  of  the  heart ;  cold 
ness  and  shivering  whenever  the  bed  clothes  are  raised, 
or  on  motion ;  fever  with  adypsia,  or  moderate 
thirst  ;  lassitude,  debility,  and  disposition  to  syncope  ; 
trembling  of  the  limbs,  from  the  slightest  exertion  ; 
sense  of  suffocation. 

Mental  and  moral  symptoms. — Agitation  ;  apprehen 
sion  ;  discouragement ;  despair. 

Administration. — From  half  a  grain  to  a  grain  of 
the  tartar  emetic,  may  be  dissolved  in  a  tumblerful  of 
pure  water,  and  given  in  teaspoonful  doses,  every 
one,  two,  three,  or  four  hours,  as  the  urgency  of  the 
case  demands. 

Phosphorus. — External  indications. — Countenance 
pale,  alternating  with  redness ;  eyes  hollow  and  sur 
rounded  by  a  blue  circle  ;  respiration  short,  difficult, 
and  noisy ;  tongue  dry ;  pulse  quick  and  hard  ;  ex 
pectoration  slimy  or  bloody. 

Physical  sensations. — Respiration  rapid,  short,  and 
difficult ;  lancinating  pains  in  the  chest,  mostly  on  the 
left  side ;  sharp  pains  on  pressing  the  intercostal 
spaces ;  anguish,  fulness  and  tension  of  the  chest ; 
palpitation  of  the  heart ;  dry,  shaking  cough,  or  cough 
with  expectoration  of  bloody  mucus  ;  weakness,  pain 
and  trembling  of  the  limbs ;  mouth  and  throat  dry  ; 
thirst. 

Mental  and  moral  symptoms. — Uneasiness  ;  melan 
choly  ;  anguish  ;  dread  of  the  future  ;  indifference  to 
everything  ;  passionate  and  irritable. 

Administration. — Same  as  bryonia. 

After  the  more  violent  febrile  symptoms  have  sub 
sided,  and  those  of  effusion  into  the  cavity  of  the  pleura 
remain, — as  enlargement  of  the  affected  side,  dull 
sound  on  percussion,  absence  ef  the  respiratory  mur 
mur,  oppression  and  constriction  of  the  chest,  difficult 
and  short  breathing,  with  occasional  attacks  of  suffo 
cation,  dry  cough,  coldness  of  the  body,  clammy  sweats, 
anxiety  and  general  sense  of  prostration,  arsenicum  is 
our  remedy.  It  may  be  given  in  these  cases,  at  the 
third  potency,  a  dose  once  in  two  to  four  hours,  length 
ening  the  intervals  as  improvement  occurs. 


334  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

Rhus  tox.  is  sometimes  useful  after  the  febrile 
symptoms  have  subsided,  and  there  yet  remain  wan 
dering  pains  in  the  chest,  shortness  of  breath,  and  gen 
eral  debility.  In  cases  also  which  have  arisen  from 
metastases  of  rheumatism  or  gout,  this  remedy  is  pe 
culiarly  appropriate.  It  may  be  administered  in  the 
same  manner  as  bryonia. 

When  inflammation  of  the  pleura  has  arisen  from  a 
contusion,  bruise,  or  other  injury,  arnica,  both  in 
ternally  and  externally,  is  our  best  specific.  For  in 
ternal  exhibition,  we  may  use  one  of  the  lower  dilu 
tions;  externally,  a  lotion  made  of  a  drachm  of  the  tinc 
ture  to  twelve  ounces  of  water. 

The  other  medicines  to  which  we  desire  to  call 
attention,  and  which  will  often  be  found  highly  ser 
viceable  in  some  of  the  sequela  of  pleuritis,  are,  sul 
phur,  scillae,  mar.,  rhus  rad.,  lachesis,  silicea,  and  china. 
Sulphur  especially,  is  recommended  by  Wurm,  in 
plastic  pleurisy,  and  in  cases  complicated  with  pneu 
monia  and  hepatization,  after  aconite  has  moderated 
the  more  active  symptoms.  He  uses  the  tincture. 

SECTION  VI. 

PERTUSSIS. WHOOPING    COUGH. 

Diagnosis. — Most  writers  recognise  three  distinct 
stages  in  whooping  cough,  viz. :  first,  the  forming 
stage,  presenting  symptoms  like  ordinary  catarrh,  as 
sneezing,  watery  eyes,  dry  cough,  headache,  constric 
tion  and  oppression  at  the  chest,  feverish  nights,  &c., 
which  continue  for  two  or  three  weeks,  when  the  sec 
ond  or  convulsive  stage  sets  in.  At  this  period  of  the 
malady,  there  are  violent  paroxyms  of  cough  of  a  con 
vulsive  and  suffocative  character.  This  cough  is  dis 
tinguished  from  others  by  a  peculiar  stridulous  or 
whooping  sound,  which  occurs  during  inspiration, 
while  the  expirations  are  interrupted  by  frequent  fits 
of  coughing.  This  whooping  sound  is  owing  to  a  spas 
modic  contraction  of  the  glottis,  which  renders  res 
piration  very  difficult,  and  gives  rise  to  a  sense  of 
obstruction  and  impending  suffocation.  This  spasm 
and  contraction,  together  with  a  tickling  in  the  throat, 
come  on  previous  to  the  paroxysms,  and  subside  some- 


DISEASES    OF    THE    RESPIRATORY    OR6ANS.  335 

•what  after  the  coughing  has  ceased.  The  duration  of 
the  paroxysms  varies  from  one  to  five  minutes,  at 
the  termination  of  which  there  is  often  vomiting  or 
expectoration  of  mucus.  This  stage  usually  acquires 
its  greatest  degree  of  violence  in  from  one  to  two 
weeks,  and  its  continuance  is  from  five  to  six  weeks, 
when  the  third,  or  stage  of  declension^  commences.  At 
this  period  all  of  the  symptoms  gradually  become  mild 
er  ;  the  paroxyms  are  less  frequent, — the  cough  less 
urgent ;  the  contraction  and  obstruction  less  strongly 
marked,  until  at  the  end  of  two  to  four  weeks,  under 
favourable  circumstances,  all  of  the  symptoms  have 
disappeared. 

Causes. — Pertussis  is  unquestionably  attributable  to 
the  absorption  into  the  organism  of  a  miasm  of  a  spe 
cific  nature.  We  know  nothing  of  its  chemical  or 
physical  character,  but  in  this,  like  other  maladies, 
the  system  must  be  rendered  susceptible  by  previous 
preparation,  or  predisposition,  to  enable  the  miasm  to 
exercise  its  specific  effects  and  induce  the  phenomena 
of  whooping  cough. 

Whether  this  specific  miasm  operates  primarily  upon 
the  mucous  membrane  of  the  air  passages,  the  stom 
ach,  the  diaphragm,  the  lungs,  or  the  eighth  pair  of 
nerves,  we  are  unable  to  decide  in  a  satisfactory  man 
ner.  It  would  seem  that  the  advocates  of  each  par 
ticular  opinion  in  regard  to  its  primary  location,  have 
found  in  their  autopsical  examinations,  appearances 
which  indicated  that  there  had  been  inflammation  in 
each  of  the  structures  alluded  to.  That  the  pneumo 
gastric  and  other  nerves,  as  well  as  the  membrane  of 
the  glottis,  larynx,  &c.,  are  involved,  either  as  a  prima 
ry  or  secondary  effect  of  the  contagion,  there  can  be 
no  question. 

The  causes  which  act  upon  the  organism  in  such  a 
manner  as  to  render  it  susceptible  to  the  action  of  the 
miasm,  are,  atmospheric  vicissitudes,  colds,  debility 
and  chronic  diseases  of  the  respiratory  organs,  inhala 
tion  of  irritating  substances,  fatigue  and  exhaustion  of 
the  physical  or  nervous  system. 

Therapeutics. — In  the  first  stage  of  the  malady  the 
ordinary  remedies  for  catarrh  are  appropriate,  as  nux 


336  DISEASES    OP    THE    RESPIRATORY    ORGAN?. 

vom.,  chamomela,  belladonna,  ipecacuanha,  mercurius, 
aconite,  dulcamara,  pulsatilla,  arnica,  bryonia,  fyc. 

In  the  second,  or  convulsive  stage,  the  best  remedies 
are,  tartar  emetic,  veratrum  alb.,  carbo  veg.,  chamomela, 
cuprum  acetat.,  sambucus  nig.,  conium  mac.,  drosera, 
hyoscyamus,  ipecacuanha,  nux  vom. 

In  the  third  stage,  we  may  consult,  in  addition  to 
the  medicines  already  enumerated,  pulsatilla,  hepar 
sulph.,  sulphur,  lachesis,  arsenicum,  sepia,  acid  phos., 
and  china. 

Dr.  Bosh  speaks  very  strongly  in  favour  of  cuprum 
metallicum  in  firmly  developed  whooping  cough. 

"  In  simple  whooping  cough  of  children  under  one 
year  of  age,  I  give  in  the  morning  and  evening,  cuprum 
third,  one  grain  ;  in  older  children,  cuprum  second,  one 
grain  twice  a  day,  and  in  this  way  the  disease  was 
generally  removed  under  gradually  decreasing  cough 
ing  turns."  When  the  cough  is  complicated  with 
symptoms  arising  from  dentition,  or  other  affections 
disconnected  with  the  cough,  these  symptoms  should 
be  met  by  appropriate  remedies,  either  alone,  or  in 
alternation  with  cuprum. 

Administration. — Our  attenuations  may  range  from 
the  first  to  the  sixth,  in  this  disease,  according  to  the 
age,  temperament,  and  impressibility  of  the  patient. 
The  doses  should  be  repeated  at  intervals  of  six  or 
eight  hours. 

SECTION    VII. 

ASTHMA. 

Diagnosis. — For  a  week  or  two  previous  to  an  at 
tack  of  asthma,  the  patient  will  often  be  troubled  with 
sneezing  every  morning,  itching  at  the  inner  canthi  of 
the  eyes,  irritation  of  the  throat,  with  constant  dispo 
sition  to  hem  or  hack,  lassitude,  dull  pains  in  the  head, 
back,  and  limbs,  loss  of  appetite,  dry  hacking  cough, 
and  great  depression  of  spirits. 

The  attack  most  commonly  commences  during  the 
night,  with  tightness  and  constriction  about  the  chest; 
urgent  and  distressing  dyspnoea,  aggravated  by  the 
slightest  movement ;  inspirations  short  and  strong, 
while  the  expirations  are  long,  laboured,  and  wheez- 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  337 

ing  ;  great  and  rapid  movement  of  the  nostrils ;  coun 
tenance  bloated  and  livid,  and  indicative   of  intense 
distress  and  anxiety ;  inclination  to  retain  the  erect 
position  ;  even  during  the  forming  symptoms,  inability 
to  lie  upon  the  right  side  or  back  ;  more  or  less  prick 
ling  or  burning  heat  after  the  attack  commences,  ag 
gravated  by  scratching  ;  symptoms  aggravated  by  eat 
ing  even  bread ;  respiration  very  difficult,  as  if  from 
want  of  air,  yet  the  wind  from  a  fan  or  the  draft  from 
a  door  or  window,  stops  the  breath,  and  cannot  be 
borne  ;  face  and  forehead  livid,  or  pale ;  sharp  pain 
through  the  temples ;  inability  to  lie  upon  a  feather 
bed  from  the  first ;  during  the  paroxysm  must  con 
stantly  retain  the  erect  posture ;  the  dyspnoea,  &c., 
worse  in  the  night,  and  remitting  during  the  day  ;  dry 
cough  in  the  first  instance,  sometimes  but  not  always, 
followed  in  a  few  hours  by  expectoration  of  a  viscid 
mucus;  perfume  of  flowers,  hay,  &c.,  increases  the 
symptoms,  and  almost  puts  a  stop  to  the  breath  during 
the  paroxysm ;  extremities  cold ;  respiration  through 
the  mouth ;  attacks  brought  on  from  excitement,  par 
ticularly  grief  and  fear ;  also  certain  odours  or  irritating 
substances  inhaled ;   palpitation   during  the  attack ; 
the  asthma  occurs  for  the  most  part  during  the  season 
of  flowers ;  tongue  foul ;    breath   offensive ;    eructa 
tions  ;  flatulency ;  urgent  desire   for  cool,  fresh   air ; 
pulse  variable. 

Causes. — It  has  been  often  observed  that  asthma  al 
most  always  occurs  in  individuals  who  are  suffering 
from  some  chronic  miasm.  In  numerous  instances 
we  have  been  able  to  trace  a  direct  connection  be 
tween  an  attack  of  urticaria,  but  partially  developed, 
and  then  suddenly  suppressed,  and  asthma.  Indeed, 
it  may  be  safely  asserted,  that  a  majority  of  the  cases 
of  true  asthma,  are  attributable  to  this  or  some  other 
miasm,  which  has  been  thrown,  from  some  exciting 
cause,  upon  some  portion  of  the  respiratory  apparatus. 
We  are  confirmed  in  this  opinion,  from  the  fact  that 
in  several  instances  where  an  attack  of  asthma  has 
been  seriously  threatened,  and  even  commenced,  w« 
have  been  able  to  cut  it  short  by  administering  a  re 
medy  like  puls-j  bry.,  and  cup.  acet.,  which  had  the  ef- 

15 


338  DISEASES    OP    THE    RESPIRATORY    ORGANS. 

feet  to  develop  the  nettle  rash,  and  thus  relieve  the 
air  passages. 

Other  causes,  which  are,  properly  speaking,  excit 
ing  causes,  may  be  enumerated,  as  humid  easterly 
winds,  atmospheric  vicissitudes,  inhalation  of  certain 
medicinal  and  other  irritating  substances,  like  ipecac., 
the  odours  of  certain  plants,  and  electricity  in  the  air, 
the  inhalation  of  the  imponderable  particles  of  which 
often  causes  severe  paroxysms  of  the  malady  ;  also  in 
digestible  food,  anger,  fear,  the  irritation  of  pregnancy, 
spinal  disease,  sedentary  habits,  &c. 

Therapeutics. — Pulsatilla,  ipecacuanha,  arsenicum, 
bryonia,  nux  vomica,  belladonna,  china,  sulphur,  lobelia 
inflata,  coffea,  digitalis,  and  acid  hydrocyanic?  are  the 
principal  remedies  in  this  complaint. 

Pulsatilla. — This  remedy  is  indicated  in  cases  oc 
curring  in  persons  of  a  mild  temper,  light  complexion, 
hair  and  eyes,  from  suppressed  or  confined  rash,  ces 
sation  or  other  derangement  of  the  menses,  and  inha 
lation  of  the  vapour  of  sulphur.  The  external  indica 
tions  are:  short,  suffocating,  and  extremely  difficult 
respiration,  as  if  from  want  of  sufficient  air,  or  choked 
by  some  irritating  substance ;  the  patient  is  obliged 
to  retain  the  erect  posture  ;  his  movements  are  rapid, 
and  his  whole  appearance  indicates  great  distress  and 
anxiety  ;  tongue  loaded  with  a  thick  coating  ;  breath 
offensive  ;  frequent  eructations  ;  hiccough  ;  counte 
nance  pale,  sometimes  alternating  with  redness  ;  at 
tacks  usually  coming  on  in  the  night  during  sleep. 

Physical  sensations. — Cramp-like  and  constrictive 
tension  of  the  chest  or  larynx  ;  respiration  impeded 
and  distressing,  increased  by  motion,  walking  in  the 
open  air,  or  by  eating  ;  short  spasmodic  cough  ;  nau 
sea  ;  palpitation  of  the  heart  ;  sensation  of  fulness  and 
distention  in  the  stomach  ;  throbbing  pain  in  the  fore 
head  ;  bad  taste  in  the  mouth  ;  cramp-like  pains  in 
the  abdomen  ;  itching,  burning,  or  prickling  sensation 
in  the  skin,  in  the  evening  or  during  the  night  ;  pains 
in  the  limbs  ;  nausea  and  vomiting ;  smarting  or  burn 
ing  pain  in  the  canthi,  and  pressure  in  the  eyeballs. 

Mental  and  moral  symptoms. — Very  great  depression 
of  spirits,  and  melancholy  from  the  onset  of  the  symp- 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  839 

toms ;  intense  anxiety,  agitation  and  dread  of  suffoca 
tion  during  the  paroxysms. 

Administration. — From  the  third  to  the  sixth  dilu 
tion  may  be  used — a  dose  every  half  hour  in  urgent 
cases — until  aggravation  or  amendment  occurs. 

Ipecacuanha. — In  asthma  caused  by  the  suppression 
of  miliaria,  urticaria,  and  by  the  inhalation  of  irritat 
ing  vapours,  ipecacuanha  at  the  first  to  the  third  at 
tenuation,  may  be  exhibited.  The  signs  which  par 
ticularly  indicate  this  medicine,  are,  spasmodic  con 
traction  of  the  larynx  and  chest ;  anxious,  sighing,  or 
panting  respiration ;  palpitation  of  the  heart ;  air 
seems  full  of  dust ;  face  pale  ;  extremities  cold  ;  nau 
sea  ;  vomiting  ;  coated  tongue  ;  insipid  or  bitter  taste  ; 
dry,  spasmodic  cough ;  irritability,  impatience  and 
fear  of  death. 

Arsenicum  alb.,  is  a  valuable  remedy  in  bad  cases 
occurring  from  suppressed  eruptions  or  catarrh,  also 
in  persons  of  feeble  or  impaired  constitutions,  whether 
from  excesses,  previous  sickness,  or  old  age.  The  fol 
lowing  symptoms  point  especially  to  this  medicine,  viz. : 
feeling  of  extreme  lassitude  and  debility  ;  difficult, 
stifling  dyspnoea,  with  attacks  of  suffocation  ;  spas 
modic  constriction  of  the  larynx  and  chest :  respiration 
short,  anxious,  and  wheezing  ;  irregular  throbbings  of 
the  heart  ;  sufferings  aggravated  at  night  by  lying 
down,  movement,  eating,  mental  excitements,  or  ex 
posure  to  the  cool  fresh  air  ;  distention  and  cramp-like 
pains  in  the  abdomen  ;  frequent  eructations  ;  nausea  ; 
vomiting  ;  burning  sensation  at  the  stomach  ;  foetid 
breath  ;  smarting  or  burning  sensation  in  the  throat  ; 
pressive  burning  pains  in  the  eyes  ;  face  pale  or  bluish  ; 
anxious  and  desponding.  The  first  to  the  third  tritu- 
ration  may  be  employed,  regulating  the  repetition  ac 
cording  to  the  urgency  of  the  symptoms. 

Bryonia  is  applicable  in  cases  arising  from  sup 
pressed  eruptions,  or  rashes  but  partially  developed. 
It  is  also  appropriate  in  cases  complicated  with  catar- 
rhal  and  pulmonary  disorder. 

The  paroxysm  usually  occurs  in  the  night ;  the  res 
piration  is  difficult,  short,  sighing,  impeded  by  sting- 
ings  in  the  chest,  and  aggravated  by  exercise  ;  there 
are  oppressive,  tensive  or  contractive  pain  in  the  chest: 


340  DISEASES    OF    THE    RESPIRATOR?    ORGANS. 

cramp-like  pains,  cuttings  or  shootings  in  the  abdo 
men  ;  bitter  or  acid  eructations  ;  throbbing  or  pres- 
sive  pains  in  the  head,  increased  by  movement  ;  pres 
sure  and  burning  pain  in  the  eyes  on  motion.  It  may 
be  exhibited  in  the  same  manner  as  pulsatilla. 

Asthma  which  has  been  caused  by  derangement  of 
the  digestive  functions,  excessive  study  and  watching, 
sedentary  habits,  and  abuse  of  drugs,  liquors,  coffee, 
&c.,  may  often  be  cured  by  the  use  of  nux. 

The  nux  symptoms  are,  weight  and  constriction  at 
the  chest  ;  great  difficulty  of  breathing,  aggravation 
of  the  symptoms  in  the  night,  on  walking,  eating,  or 
lying  down  in  the  evening  ;  heat  and  burning  in  the 
chest ;  bitter  and  acid  eructations  ;  pressure  and  con 
tractive  pains  in  the  stomach  and  epigastrium  ;  pal 
pitation  of  the  heart  ;  short,  dry,  spasmodic  cough, 
sometimes  attended  with  a  scraping  in  the  throat  ; 
fetid  breath  ;  loaded  tongue  ;  heartburn ;  distention 
of  the  abdomen  after  eating  ;  heaviness,  or  tearing, 
throbbing,  drawing  or  jerking  pains  in  the  head  ;  fre 
quent  sneezing,  with  coryza ;  hypochondria,  anxiety 
and  irritability.  It  may  be  employed  like  pulsatilla. 

Belladonna  has  been  especially  recommended  in 
cases  occurring  in  females  of  an  irritable  constitution, 
also  in  cases  where  there  exists  a  tendency  to  spasms, 
or  any  organic  lesion.  Hartmann  asserts  that "  it  often 
proves  radically  curative  after  the  exhibition  of  some 
intercurrent  remedy,  particularly  in  cases  which  have 
not  become  too  chronic  by  repeated  relapses,  under 
which  circumstances  we  must  have  recourse  to  sul 
phur,  calcarea,  or  some  other  proper  antipsoric." 

It  is  particularly  called  for  when  the  paroxysms 
come  on  in  fits  of  short,  difficult,  irregular,  and  suffo 
cating  respiration,  accompanied  by  dry  cough  ;  pres 
sure  on  the  chest;  violent  beatings  of  the  heart  ;  ver 
tigo,  swimming  or  darting  pains  in  the  head  ;  pains 
in  the  small  of  the  back  and  limbs  ;  cramps  in  different 
parts  of  the  body  ;  anxiety,  irritability,  and  fretful- 
ness. 

A  dose  of  the  second  or  third  dilution  every  hour  or 
two  until  an  impression  is  produced. 

Chamomela  is  an  important  remedy  in  the  flatulent 
asthma  of  children,  also  that  following  a  suppressed 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  341 

catarrh.  It  is  likewise  specific  in  those  attacks  which 
are  caused  by  anger,  grief,  fear,  &c.,  in  adults.  Among 
the  symptoms  which  point  to  it,  may  be  mentioned, 
distention  and  sense  of  fulness  of  the  stomach  and 
bowels ;  pressure,  anxiety,  and  fulness  in  the  region 
of  the  heart  ;  short,  wheezing  respiration  ;  great  rest 
lessness  ;  dry  irritating  cough  ;  bad  taste  ;  tainted 
breath. 

Administration. — Same  as  of  belladonna. 

Lobelia  inflata  is  a  remedy  of  great  value  in  cases  of 
spasmodic  asthma  induced  by  humidity,  and  certain 
other  conditions  of  the  atmosphere.  It  is  indicated 
when  the  attack  is  preceded  or  accompanied  by  a  kind 
of  "  prickly  sensation  through  the  whole  system,  even 
to  the  extremities  of  the  fingers  and  toes ;''  constric 
tion  across  the  chest;  short,  anxious  and  wheezing 
respiration  ;  nausea  ;  vomiting  ;  sense  of  prostration  ; 
trembling  of  the  limbs  ;  giddiness  and  headache  ;  spas 
modic  cough  ;  burning  sensation  in  passing  urine  ;  in 
termittent  pulse  ;  cramp-like  pains  in  the  abdomen  ; 
cold  sweats. 

Administration. — Potencies  from  the  third  to  the 
sixth, — a  dose  every  two  to  four  hours,  as  the  symp 
toms  require. 

In  cases  of  asthma  of  long  standing,  and  which 
appear  to  be  connected  with  some  chronic  miasm 
lurking  in  the  organism,  sulphur,  digitalis,  acid  hydro- 
cyanic,  calcarea,  &c.,  are  worthy  of  consideration,  and 
will  sometimes  effect  cures  when  the  other  medicines 
enumerated  have  disappointed  our  expectations. 

There  are  other  remedies,  like  coffea,  ignatia,  stramo 
nium,  china,  arsenic,  arnica,  &c.,  which  should  always 
be  borne  in  mind  by  the  practitioner,  for  instances  may 
occur  in  certain  complicated  cases,  where  one  or  more 
of  them  will  be  required. 

SECTION  VIII. 

PHTHISIS    PULMONALIS. CONSUMPTION. 

We  come  now  to  the  consideration  of  that  disease 
which  has  proved  the  most  destructive  of  human  life 
of  all  that  claim  the  attention  of  the  profession.  Slow, 
insidious,  and  gentle  in  its  progress,  from  causes 


342  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

which  have  been  in  operation  for  years,  it  steadily 
draws  its  victims  to  the  brink  of  the  grave,  before  they 
have  an  apprehension  of  danger,  or  are  conscious  of 
even  serious  indisposition.  We  are  accustomed  to 
regard  with  terror  the  yellow  fever,  because  its  sub 
jects  are  seized  suddenly,  and  destroyed  by  a  single 
blow.  But  if  this  fearful  agent  of  death  possesses,  in 
the  torrid  climates  to  which  it  is  almost  always  con 
fined,  a  nearly  indiscriminate  and  unlimited  dominion, 
during  two  or  three  of  the  sultriest  months  of  summer, 
consumption,  with  its  deliberate  and  almost  invisible 
step,  traverses  all  the  world,  destroying  in  its  treach 
erous  and  fatal  embrace  innumerable  numbers,  of 
every  age,  and  sex,  and  condition.  The  yellow  fever 
indeed  strikes  suddenly  and  violently,  and  leaves  the 
patient  no  hope  or  consolation  ;  but  consumption 
quietly  and  gently  fastens  its  chains  upon  its  victims, 
while  brightening  the  intellect,  charming  the  spirit, 
and  tinting  the  cheeks  with  the  colours  of  the  lily  and 
the  rose,  distracting  their  attention  with  songs  of  hope 
and  security  ;  and  the  poison  pervades  its  subject 
organs,  and  the  deluded  patient  sooner  or  later  awakes, 
from  his  fancied  safety,  scarcely  in  time  to  realize  his 
peril  ere  he  yields  his  life. 

How  few  physicians  are  there,  of  extensive  practice, 
whose  diaries  might  not  furnish  histories  of  the  most 
touching  pathos,  in  connection  with  the  treatment  of 
this  disease,  which  (it  may  be  by  a  perversity  of  the 
judgment)  seems  to  fulfil  its  mission  in  disappointing 
the  fondest  expectations,  and  in  blighting  the  fairest 
creations  of  human  loveliness  !  A  maiden,  perhaps, 
becomes  the  belle  of  the  season,  in  which  she  makes 
her  entrance  into  the  gay  world.  To  an  assured  po 
sition  of  the  highest  elevation  in  society,  she  brings 
the  most  exquisite  physical  beauty,  and  grace  and 
elegance  of  manner,  and  the  finest  and  rarest  moral 
and  mental  endowments,  subtlest  intelligence  and 
quickest  wit,  and  a  sweetness  of  disposition  which 
crowns  a  sudden  admiration  with  the  dearest  and 
most  permanent  affection.  When  Hope  comes  to  her 
with  the  most  enchanting  promises,  the  Angel  of  111 
approaches  also,  in  the  guise  of  consumption,  and  the 
two  contend  until  the  last  is  victor,  and  his  triumph  is 


DISEASES    OP   THE    RESPIRATORY    ORGANS.  343 

celebrated  with  all  the  displays  of  unaffected  wo.  Or 
it  is  a  young  man,  who  has  scaled  the  difficult  heights 
that  obstructed  an  ambitious  vision,  and  is  about  to 
grasp  the  prize  upon  which  his  eagle  eye  has  been 
steadily  fixed  through  years  of  varying  toils  and 
storms.  The  moment  he  dares  to  dream  of  rest,  the 
enemy  that  has  dogged  his  steps,  unseen,  through  half 
his  career,  is  disclosed,  and  leads  him  from  the  pre 
sence  of  Hope  into  that  of  Despair.  With  what  a 
profound  interest  must  the  physician  contemplate  a 
disease  of  which  the  path  is  constantly  thus  marked  ! 
True  tubercular  phthisis,  when  once  fully  developed, 
is  beyond  question  incurable  by  medical  means.  The 
physician  may  palliate  symptoms,  and  often  protract 
for  a  considerable  period  the  fatal  termination  of  the 
malady,  but  he  cannot  remove  those  foreign  accumu 
lations  which  constitute  tubercles,  either  by  a  gradual 
absorption  or  in  any  other  manner,  so  as  to  prevent  the 
formation  of  ulcerous  excavations,  nor  can  he  heal 
these  ulcerous  cavities  when  once  formed,  since  they 
are  constantly  being  disturbed  and  irritated  by  the  in 
cessant  motions  of  the  lungs.  The  few  instances  of 
spontaneous  cures  of  ulcerated  lungs,  reported  by 
Laennec  and  others,  are  only  exceptions  to  the  gene 
ral  principle  which  we  have  advanced.  Much,  how 
ever,  may  be  done  in  the  early  stages  of  phthisis,  while 
the  tubercles  are  yet  small,  and  but  slightly  irritated, 
to  retain  them  in  a  latent  condition  for  an  indefinite 
number  of  years.  We  are  aware  that  in  some  in 
stances  there  will  be  great  difficulty,  even  on  the  part 
of  the  physician,  in  detecting  the  insidious  advances 
of  the  disease  at  this  early  period,  but  by  watching 
with  great  care  every  slight  indication  of  disturbance 
connected  with  the  respiratory  organs,  by  ascertaining 
whether  any  hereditary  predisposition  exists  in  the 
family,  by  examining  the  physical  conformation  of  the 
chest,  the  respirations,  as  relates  to  their  strength, 
freedom,  number  per  minute,  and  whether  unduly  in 
creased  by  exercise  ;  and  finally,  by  investigating 
minutely  the  previous  history  of  the  individual,  in 
order  to  be  able  to  judge  whether  any  cause  may  have 
been  in  operation  which  might  originate  the  disorder, 
we  may  be  able  to  advise  such  measures  as  shall  re- 


344  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

tain  the  tubercles  in  a  latent  and  undeveloped  condi 
tion,  and  thus  for  years  prolong  life. 

The  most  common  period  for  the  occurrence  of 
phthisis  is  between  the  ages  of  eighteen  and  thirty ; 
and  it  is  probable  that  more  deaths  occur  in  persons 
under  the  age  of  eighteen,  than  after  thirty.  It  is 
calculated  by  Drs.  Forbes  and  Clark,  "  that  above  one 
quarter  part  of  the  individuals  who  die  before  the  age 
of  puberty,  die  with  tubercles  !"  It  is  also  estimated 
by  the  latter  gentleman,  "  that  the  maximum  of  mor 
tality  in  this  disease  is  at  thirty,  and  that  from  this 
point  it  gradually  diminishes."  No  age,  however,  is 
exempt  from  it ;  for  infancy,  childhood,  youth,  man 
hood,  and  extreme  old  age,  are  all  more  or  less  sub 
ject  to  its  withering  attacks. 

Females  also  suffer  more  from  the  malady  than 
males,  as  is  shown  by  the  statistical  facts  which  have 
been  published  by  Louis,  Forbes,  Skoda,  Laennec, 
Andral,  Clark,  Young,  and  others.  Nor  is  this  at  all 
surprising,  when  we  reflect  upon  the  education,  and 
the  habits  of  life  of  the  women  of  civilized  countries. 
Born  and  reared  during  infancy  in  hot-houses,  where 
the  invigorating  breath  of  heaven  rarely  penetrates  ; 
their  childish  intellects  crammed  with  ideas  which 
they  are  unable  to  understand,  while  their  physical 
frames  are  permitted  to  wither  in  crowded  school 
rooms,  without  that  free  and  abundant  exercise  and 
indulgence  in  childish  sports,  which  are  so  absolutely 
essential  to  their  growth  and  well  being  ;  submitted  at 
the  period  of  puberty  to  those  instruments  of  torture 
and  distortion,  stays,  in  order  that  the  symmetrical 
figures  which  God  in  his  wisdom  has  given  them,  may 
be  contracted  sufficiently  to  meet  the  ideas  of  an 
abominable  fashion  ;  rejecting  constant  and  vigorous 
exercise  in  the  open  air,  early  hours,  regular  habits, 
and  all  of  those  means  which  tend  to  promote  physical 
strength  and  vigour :  is  it  strange,  in  view  of  these 
things,  that  the  seeds  of  phthisis  are  so  often  and  so 
early  planted  ? 

There  are  habits  also  prevalent  among  the  youth  of 
the  male  sex,  which  conduce  in  an  alarming  degree  to 
generate  and  develope  phthisical  affections.  The  vice 
to  which  we  allude,  from  false  delicacy,  from  its  soli- 


DISEASES    OF    THJ5    RESPIRATORY    ORGANS.  345 

tary  nature,  and  from  the  very  gradual  manner  in 
which  it  impairs  the  nervous  system  and  undermines 
the  constitution,  has  either  been  entirely  overlooked, 
or  but  slightly  touched  upon  by  writers.  But  unless 
we  are  much  deceived,  a  very  large  number  of  con 
sumptive  cases,  especially  in  young  men,  are  attribut 
able  to  onanism,  as  their  remote  cause ;  and  we  are 
sure  that  those  who  have  minutely  investigated  the 
previous  histories  of  consumptive  patients,  will  fully 
coincide  with  us. 

It  is  quite  true  that  there  are  many  other  habits  and 
customs  which  pertain  to  refined  society,  that  also 
have  their  effect  in  engendering  phthisis,  but  we  be 
lieve  that  the  cause  just  touched  upon  has  been  pro 
ductive  of  more  evil  amongst  the  youth  of  the  male 
sex,  than  any  two  other  causes  combined.  This  cause 
applies,  to  some  slight  extent,  to  females,  but,  com 
pared  with  the  male  sex,  it  is  trivial  and  unimportant, 
for  the  reason  that  women  are,  by  nature,  purer,  less 
sensual,  and  less  addicted  to  gross,  carnal,  and  beastly 
thoughts,  than  a  vast  majority  of  the  other  sex. 

Let  parents,  then,  banish  all  mawkish  delicacy  upon 
this  subject,  and  caution  their  children  against  this 
dreadful  evil.  Let  them  talk  plainly,  and  display  be 
fore  their  minds  the  inevitable  consequences,  in  the 
form  of  consumption,  idiocy,  lumbar  abscess,  &c.,  to 
which  an  indulgence  in  this  degrading  and  pernicious 
vice  so  surely  leads. 

There  are  many  other  causes  of  phthisis  which  we 
might  here  dilate  upon,  but  we  shall  allude  to  them 
under  the  head  of  " causes  of  phthisis" 

The  appearance  of  the  tuberculous  formations  vary 
in  different  subjects,  some  being  small  as  millet 
seeds,  and  irregular  in  shape,  either  distinct  or  running 
into  each  other,  of  the  consistence  of  cheese,  and  of 
a  light  yellowish  colour.  This  variety,  which  is  by  far 
the  most  common,  has  been  termed  the  miliary  tuber 
cle. 

Another  variety  is  called  the  granular  tubercle, 
which,  according  to  Laennec,  is  only  the  ordinary  tu 
bercle  in  its  first  stage.  Bayle  and  Mclntosh  enter 
tain  different  opinions,  the  former  believing  the  mili 
ary  granulations  to  be  distinct  from  tubercles,  while 
15* 


346  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

the  latter  supposes  them  to  be  genuine  tubercles,  but 
sui  generis. 

Bayle,  Laennec,  and  others,  also  assert  that  they 
have  met  with  a  few  cases  which  they  term  encysted 
tubercle.  Other  writers  speak  of  the  occasional  oc 
currence  of  this  variety  of  tubercle,  it  being  semi- 
transparent,  whitish,  and  in  consistence  like  hard 
cheese. 

Laennec  describes,  likewise,  three  kinds  of  tubercu 
lous  infiltration,  viz.,  the  irregular,  the  gray,  and  the 
yellow.  This  infiltration  is  generally  formed  around 
tuberculous  excavations,  but  it  may  exist  where  there 
are  no  tubercles.  It  is  sometimes  found  in  large 
masses,  "  occupying  the  whole  lobe  of  the  lung,  and 
having  no  connection  with  the  miliary  tubercle." — Me 
Intosh. 

Respecting  the  nature  and  cause  of  these  tubercu 
lous  formations,  there  is  a  wide  difference  of  opinion. 
Broussais  supposed  that  irritation,  or  inflammation, 
were  only  "  degrees  of  the  same  affection,  and  that 
they  may  produce,  indifferently,  tubercles,  encephaloid 
cancer,  melanosis,  fibrous,  bony,  cartilaginous  growths, 
&c." 

Laennec  and  Andral  maintain  that  they  are  "  ac 
cidental  productions,  foreign  to  the  natural  organiza 
tion  of  the  lungs,"  and  caused  by  an  aberration  in  the 
nutrition  of  the  organ. 

Others  are  of  opinion  that  tubercles  are  primitively 
hydatids. 

In  the  first  stage  of  development,  tuberculous  mat 
ter  is  "  a  gray,  semi-transparent  substance,  which 
gradually  becomes  yellow,  opaque,  and  very  dense. 
Afterwards  it  softens,  and  gradually  acquires  a  fluid 
ity  nearly  equal  to  that  of  pus  ;  it  being  then  expelled 
through  the  bronchi,  cavities  are  left,  vulgarly  known 
by  the  name  of  ulcers  of  the  lungs,  but  which  I  shall 
designate  tuberculous  excavations" — Laennec. 

Whether  these  accidental  formations  are  inorganic 
substances  deposited  in  the  pulmonary  structure,  like 
pus  or  calculous  concretions,  by  a  kind  of  exudation, 
or  whether  they  are  organized,  and  possess  life  and 
vitality,  cannot  easily  be  determined.  We  incline, 
however,  to  the  latter  opinion. 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  347 

For  a  more  particular  description  of  the  morbid 
appearances  found  on  dissection,  the  reader  is  referred 
to  the  writings  of  Louis,  Laennec,  Skoda,  Bayle, 
Forbes,  and  Clarke. 

Diagnosis. — One  of  the  first  symptoms  which  an 
nounces  the  approach  of  phthisis,  is  an  undue  short 
ness  of  breath  after  exercise.  If,  in  addition  to  this, 
there  are  haemoptysis,  wandering  pains,  constriction 
and  tightness  at  the  chest,  great  sensitiveness  of  the 
lungs  to  cold  air,  a  dry  morning  cough,  a  dull  sound 
in  the  clavicular  region  on  percussion,  and  a  partial 
or  total  absence  of  the  respiratory  murmur,  the  most 
serious  apprehensions  may  be  entertained. 

Let  all  remember,  also,  that  it  is  only  at  this  early 
stage  of  the  malady,  that  our  preventive  and  remedial 
measures  can  be  brought  to  bear  with  any  assurance 
of  success,  and  on  this  account,  we  shall  dwell  par 
ticularly  upon  these  primary  indications,  trusting  that 
we  may  in  this  way  impress  upon  the  minds  of  all 
their  vital  importance. 

In  all  of  our  investigations  of  diseases  of  the  chest, 
it  is  a  matter  of  importance,  in  the  first  instance,  to 
ascertain  whether  any  hereditary  predisposition  ex 
ists  on  the  part  of  the  patient  to  tuberculous  affec 
tions.  Secondly,  whether  from  occupation,  previous 
habits,  excesses,  protracted  mental  anxiety  and  de 
pression,  and  frequent  exposure,  without  a  sufficient 
supply  of  wholesome,  nutritious  food,  the  patient  has 
not  acquired  those  peculiarities  of  constitution  which 
render  him  susceptible  to  attacks  of  phthisis  ;  and, 
thirdly,  whether  the  physical  development  of  the  chest 
is  such  that  the  lungs  can  have  ample  room  to  exer 
cise  their  functions. 

In  making  up  our  diagnosis  in  the  early  stage  of 
any  given  case,  much  will  depend  upon  the  presence 
or  absence  of  these  remote  causes,  for  most  of  the 
symptoms  enumerated  may  exist  in  a  man  with  a 
large  and  well  formed  chest,  and  with  no  hereditary 
or  acquired  predisposition  to  the  malady,  and  yet  ex 
cite  no  serious  apprehensions,  while  the  same  symp 
toms  in  an  individual  with  a  narrow,  flat,  and  ill- 
shaped  thorax,  with  a  predisposition  to  the  disease, 
would  induce  us  to  form  a  diagnosis  of  an  entirely 


348  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

different  character.  Commencing,  then,  with  the 
primitive  symptoms  of  consumption,  we  shall  notice 
first — 

The  respiration.  "  Healthy  respiration,"  according 
to  Marshall  Hall,  *<  is  performed  with  ease  and  free 
dom,  and  without  the  aid  of  the  auxiliary  muscles,  in 
any  of  the  usual  positions  of  the  body.  It  is  effected 
by  a  nearly  equal  elevation  of  the  ribs,  and  depression 
of  the  diaphragm,  except  in  females,  in  whom  the 
thorax  is  observed  to  move  more  than  in  men  ;  each 
side  of  the  thorax  moves  also  in  an  equal  degree, 
and  inspiration  and  expiration  occupy  nearly  equal 
spaces  of  time." 

Laennec  considers  the  respiration  natural  "when 
the  anterior  and  lateral  parts  of  the  chest  dilate 
equally,  distinctly,  yet  moderately,  during  inspiration, 
and  when  the  number  of  inspirations  in  a  state  of 
repose  is  from  twelve  to  fifteen  in  the  minute." 

Andral  puts  the  mean  average  of  respirations  in  a 
healthy  adult,  at  more  than  sixteen  or  eighteen  in  the 
minute,  Majendie  at  twenty,  and  some  writers  even 
as  high  as  twenty-six. 

Taking,  then,  the  mean  number  of  respirations  of  a 
healthy  adult  to  be  eighteen  per  minute,  and  bearing 
in  mind  the  natural  movements  of  the  healthy  thorax 
during  inspiration  and  expiration,  we  shall  be  enabled 
to  form  a  pretty  satisfactory  opinion  respecting  the 
condition  of  the  respiratory  organs,  by  judicious  com 
parisons  of  different  stages  of  disease  with  the  sup 
posed  natural  standard. 

We  are  convinced,  from  much  observation,  that 
Laennec,  Andral,  and  Louis,  have  laid  quite  too  little 
stress  upon  this  important  indication  ;  for,  although 
individuals  may  now  and  then  be  short  breathed  who 
have  no  tendency  towards  diseases  of  the  lungs,  yet, 
when  taken  in  conjunction  with  an  hereditary  predis 
position,  unusual  susceptibility  of  the  lungs  to  cold, 
slight,  dry,  hacking  cough,  narrow  or  flat  chest,  or  oc 
casional  wandering  pains  in  the  chest,  we  may  be 
certain  that  mischief  is  threatened. 

A  very  fleshy  person,  or  one  afflicted  with  disease 
of  the  heart,  and  certain  other  maladies,  may  be  short 
breathed  after  slight  exercise,  but  these  cases  can 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  349 

never  be  mistaken  by  the  observing  physician  as 
phthisical,  since  the  history  of  the  case,  as  well  as  the 
general  aspect  of  the  patient,  sufficiently  mark  the 
distinction  in  all  instances. 

Whenever,  therefore,  an  individual  has  more  than 
the  usual  number  of  respirations  during  repose,  the 
expirations  and  inspirations  being  unequal  in  point  of 
time,  and  is  put  out  of  breath  after  the  slightest  exer 
cise,  it  is  the  duty  of  the  physician  to  ascertain  the 
cause  of  this  unusual  action,  and  whether  consump 
tion  is  not  insidiously  approaching.  Is  his  chest  large, 
full,  and  well  developed, — are  its  movements  natural 
during  inspiration  and  expiration, — is  scrofula  heredi 
tary  in  his  family, — is  he  troubled  with  tightness  or 
pains  in  the  thorax, — is  he  subject  to  cough  upon  the 
slightest  exposure, — is  he  inclined  to  stoop  when  sit 
ting  or  walking, — is  his  respiration  sighing, — has  he  a 
slight  morning  cough, — finally,  is  the  sound  in  the 
clavicular  region,  or  in  any  other  part  of  the  chest, 
dull  on  percussion,  and  is  the  natural  respiratory  mur 
mur  absent  at  this,  or  any  other  point?  Upon  the 
presence  or  absence  of  these  symptoms  will  depend 
our  diagnosis.  Taken  as  a  whole,  they  indicate 
clearly  the  existence  of  phthisis  pulmonalis ;  and 
where  there  is  a  family  tendency  to  phthisis,  even  dull 
sound  on  percussion,  and  absence  of  the  respiratory 
murmur,  with  dyspnosa  after  ascending  a  stairs,  or 
other  moderate  exercise,  will  warrant  the  opinion  that 
tubercles  exist  in  the  lungs.  If,  furthermore,  one  or 
more  of  the  other  signs  enumerated  obtain,  our  opin 
ion  must  be  still  more  decided  and  unfavourable. 

Physical  conformation  of  the  thorax. — One  of  the 
causes  which  especially  favours  the  formation  and  de 
velopment  of  tubercles,  is  a  small,  flat,  and  contracted 
chest.  This  want  of  symmetry  and  proportion  may 
be  owing  to  natural  organization,  or  it  may  be  ac 
quired  from  indulgence  in  sedentary  habits,  stooping, 
a  neglect  to  keep  the  body  in  the  erect  posture,  and 
to  breathe  in  that  full,  free,  and  vigorous  manner 
which  is  so  essential  to  the  development  and  well- 
being  of  the  lungs. 

If  the  thorax  is  naturally  contracted  and  ill-shaped, 
a  suitable  course  of  physical  culture  should  be  promptly 


350  DISEASES    OP    THE    RESPIRATORY    ORGANS. 

adopted  and  persisted  in  until  it  has  acquired  sufficient 
size  and  symmetry.  This  result  is  practicable  in  all 
cases  by  steady  perseverance  and  energy  on  the  part 
of  the  patient. 

The  means  of  accomplishing  this  desirable  end,  are 
gymnastic  and  other  exercises  which  particularly  bring 
into  action  the  muscles  of  the  chest,  constant  exercise 
with  the  body  erect,  in  the  open  air,  the  habit  of  tak 
ing  long,  free  and  full  inspirations  in  order  that  all 
portions  of  the  lungs  may  constantly  receive  a  due 
proportion  of  air,  and  thus  execute  their  functions 
properly,  and  lastly,  the  use  of  tubes  for  the  purpose  of 
exercising  more  efficiently  the  pulmonary  organs.  By 
a  regular  and  systematic  employment  of  these  means, 
the  size  of  the  chest  may  be  increased  to  a  surprising 
extent,  and  the  lungs  made  to  acquire  a  degree  of 
strength  and  vigour  which  could  have  been  attained 
by  no  other  method. 

There  are  other  instances  where  well-formed  chests 
are  contracted,  distorted,  and  weakened,  by  the  wear 
ing  of  tight  clothing,  stays,  fyc.,  and  by  sedentary  oc 
cupations  and  habits,  with  the  body  constantly  inclined 
forward  and  bent  over.  These  pernicious  habits  are 
so  commonly  indulged  in,  and  have  become  so  much 
a  part  of  our  social  system,  that  their  important  in 
fluences, — their  baneful  consequences  upon  the  most 
vital  part  of  the  organism,  are  almost  entirely  over 
looked.  Yet  no  one  who  reasons  at  all,  can  be 
unaware  of  the  dangerous  and  undermining  effects  of 
these  things  ;  and  to  those  whose  pride,  or  indolence, 
or  imbecility,  still  prompts  them  to  persist  in  such 
habits,  we  would  say,  and  without  much  sympathy  for 
their  sufferings,  "  you  have  sown  the  wind,  and  you 
shall  reap  the  whirlwind." 

Hereditary  and  acquired  predisposition  to  phthisis. — 
An  alarming  circumstance  connected  with  the  his 
tory  of  any  individual,  even  when  no  symptoms  point 
to  an  approaching  consumption,  is  an  hereditary  pre 
disposition  to  tuberculous  disease  of  the  lungs.  To 
know  that  the  seeds  of  a  dreadful  malady  are  implant 
ed  in  the  system,  liable  at  any  moment  to  be  roused 
into  activity  by  the  numerous  exciting  causes  which 
prevail,  is  enough,  one  would  naturally  suppose,  to 


DISEASES    OP    THE    RESPIRATORY    ORGANS.  351 

call  forth  all  of  the  energies  of  the  individual  in  order 
that  he  may  escape  the  threatened  evil ; — yet  how  few 
under  such  circumstances  use  proper  means  of  pre 
vention,  and  exercise  that  care  and  attention  towards 
themselves  which  these  cases  require  ! 

But  the  root  of  the  evil  must  be  traced  farther  back 
to  those  injudicious  marriage  connections,  where  one 
or  both  of  the  parties  are  labouring  under  a  scrofulous 
taint.  It  appears  singular  that  intelligent  persons  of 
this  description  should  be  willing  to  enter  the  matri 
monial  state,  when  they  are  so  certain  of  entailing  upon 
their  offspsring,  disease,  misery,  and  an  early  death; 
yet  how  often  do  we  see  the  desire  for  temporary  self- 
gratification,  for  riches,  display,  or  pride,  outweigh  the 
potent  reason  named,  and  induce  the  unfortunate  vic 
tim  of  the  malady,  to  plunge  herself  and  her  children 
into  almost  certain  future  suffering  ! 

A  predisposition  to  phthisical  affections  is  often  ac 
quired  by  constant  exposure  in  small,  damp,  anj  ill- 
ventilated  habitations,  insufficient  clothing,  scanty  and 
unwholesome  food,  free  use  of  pork,  incessant  occupa 
tion  in  close  rooms  and  constrained  positions,  onanism, 
protracted  depression  of  spirits,  and  certain  occupa 
tions,  like  the  stone-cutter,  scythe-grinder,  &c. 

All  of  these  causes  exert  a  powerful  influence  in 
bringing  the  system  into  that  condition  which  renders 
it  peculiarly  susceptible  to  tuberculous  formations  in 
the  lungs,  and  for  this  reason,  should  be  avoided  as 
much  as  possible  by  individuals,  and  should  receive 
the  attention  of  all  benevolent  men. 

Amongst  the  first  signs  which  should  lead  us  to  sus 
pect  latent  phthisis,  are,  an  ill-formed  thorax,  respira 
tions  above  the  natural  standard,  and  greatly  acceler 
ated  on  slight  exercise,  and  the  existence  of  an  heredi 
tary  taint.  Whenever  these  signs  obtain,  the  chest 
should  be  at  once  explored  by  auscultation,  and  per 
cussion,  so  that  if  tubercles  are  discovered,  immediate 
measures  may  be  taken  to  keep  back  or  prevent  their 
development.  Sometimes  a  slight  dry  cough,  with 
tightness  and  pains  in  the  lungs,  are  the  first  symptoms 
which  announce  the  affection  :  at  other  times  the  dis 
ease  supervenes  suddenly,  after  a  pleurisy,  or  an  in 
fluenza,  or  some  other  acute  malady.  In  the  majority 


352  DISEASES    OP    THE    RESPIRATORY    ORGANS. 

of  instances,  however,  the  symptoms  occur  in  the  order 
enumerated,  viz.,  habitual  shortness  of  breath,  especi 
ally  after  exertion,  short  and  dry  cough,  burning  in 
the  palms  of  the  hands  and  soles  of  the  feet,  constric 
tion  and  pains  in  the  chest  on  inspiration,  sensitiveness 
of  the  lungs  to  cold.  These  symptoms  may  remain 
stationary  for  months  or  years,  when  from  some  exci 
ting  cause  the  pulse  becomes  unnaturally  frequent, 
there  are  febrile  exacerbations  in  the  evening,  and  gen 
erally  about  noon,  the  respiration  becomes  more  rapid 
and  laborious,  being  often  executed  by  the  diaphragm, 
the  anterior  and  lateral  parts  of  the  chest  dilate 
unequally  during  inspiration  and  expiration,  particu 
larly  in  the  recumbent  posture,  the  catemenia  in  fe 
male  subjects  cease,  a  mucous  expectoration  occurs, 
profuse  night  sweats  and  diarrhoaa  set  in,  the  body 
wastes  away,  the  expectoration  becomes  gradually 
more  purulent  and  abundant,  the  body  is  bent  forward  ; 
as  the  tubercles  soften,  the  guggling  or  rattle  of  the 
matter  may  be  heard  either  with  the  naked  ear  or  the 
stethoscope,  the  cough  is  cavernous,  the  respiration  and 
rattle  also  become  cavernous,  and  pectoriloquism  is 
heard  as  soon  as  the  softened  tuberculous  matter  is 
thrown  off,  and  the  cavity  becomes  empty ;  the  sound 
on  percussion  still  continues  dull,  but  now  and  then  a 
peculiar  metallic  sound  is  evident.  As  the  disease 
progresses  towards  the  last  stage,  and  the  cavities  ac 
quire  a  large  size,  the  respiration,  voice  and  cough 
give  forth  the  peculiar  hollow,  metallic  sound  or  buz 
zing,  termed  amphoric  resonance.  The  whole  body 
now  presents  the  appearance  of  extreme  emaciation, 
the  face  is  pale,  cadaverous,  and  frequently  tinged 
with  a  waxen  or  lemon  hue,  the  lips  and  roots  of  the 
nails  are  bluish,  the  nose  pointed,  the  voice  becomes 
hoarse,  the  mouth  and  throat  apthous.  the  feet  osdema- 
tous,  occasional  delirium  at  night,  and  a  continual 
failing  of  the  physical  powers,  until  death  ensues. 

Hasmoptysis,  though  not  a  necessary  attendant  upon 
phthisis,  is  of  general  occurrence  during  some  part  of 
its  course  :  it  may  occur  at  any  period  of  the  disease, 
but  most  commonly  it  is  one  of  the  first  symptoms. 

Causes   of  Phthisis. — The    causes   of  consumption 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  353 

may  be  divided  into,  first,  the  constitutional  ;  second, 
the  accidental  ;  and  third,  the  exciting. 

Under  the  first  head  may  be  included,  first,  heredi 
tary  scrofulous  taint  ;  second,  hereditary  impurities  of 
the  blood  of  a  syphilitic,  erysipelatous,  or  psoric  char 
acter  ;  third,  imperfect  organization  of  the  thorax, 
feeble  constitution  ;  and  fourth,  a  melancholy  nervous 
temperament. 

The  most  prominent  accidental  causes,  are,  confine 
ment  in  close,  crowded,  and  ill  ventilated  apartments, 
protracted  mental  depression,  insufficient  nourishment, 
unwholesome  food,  intemperance,  damp  and  unpro 
tected  habitations,  onanism,  the  habit  of  stooping,  and 
thus  contracting  the  capacity  of  the  chest,  tight  cloth 
ing,  late  hours,  over-excitement,  abuse  of  drugs,  es 
pecially  mercury  and  opium,  excesses  in  venery,  want 
of  exercise,  and  abuse  of  tobacco. 

The  exciting  causes,  are,  atmospheric  vicissitudes, 
suppression  of  the  perspiration  by  cold,  imperfectly 
subdued  acute  diseases  of  the  pulmonary  organs,  re 
pelled  cutaneous  eruptions,  inhalation  of  irritating 
vapours,  etc.,  external  injuries.  Of  these  proximate 
causes,  Eberle,  Laennec,  and  others,  consider  cold  by 
far  the  most  common  and  dangerous.  It  is  probable, 
however,  that  cold  of  itself  is  by  no  means  so  injurious 
as  these  gentlemen  have  supposed,  but  that  the  sud 
den  alternations  from  heat  to  cold  which  obtain  in 
temperate  latitudes,  exert  far  more  influence  in  engen 
dering  phthisis,  than  the  severe  but  steady  cold  of  more 
northern  regions.  Indeed,  some  recent  writers  have 
strongly  recommended  a  change  from  temperate  to 
cold  latitudes,  as  more  advantageous  to  consumptive 
subjects  than  a  warm  climate.  In  this  opinion  we  do 
not  coincide,  since  the  highly  condensed  air  of  the 
former  must  act  as  a  constant  and  powerful  stimulus 
to  the  already  irritable  tubercles.  We  much  prefer  a 
warm,  mild,  and  equable  climate  in  these  cases. 

Therapeutics. — In  all  cases  when  it  is  well  ascer 
tained  that  tubercles  exist  in  the  lungs,  either  in  a 
latent  or  partially  developed  state,  the  following  course 
should  be  adopted,  as  far  as  circumstances  will  ad 
mit,  viz. : 

First,  an  immediate  removal  to   an    equable,  mild, 


354  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

dry,  and  healthy  climate.  In  making  this  selection, 
we  should  choose  the  interior  of  the  country,  rather 
than  the  coast,  in  order,  as  far  as  possible,  to  be  away 
from  the  influence  of  the  breezes  which  blow  from  the 
ocean. 

Second,  constant  exercise  in  the  open  air.  By  this 
we  do  not  mean  that  snail-like  moping  around,  with 
the  body  coiled  up,  and  a  countenance  the  picture  of 
melancholy  and  despair  ;  but  that  vigorous,  free  and 
cheerful  exercise  which  invigorates  and  expands  the 
physical  powers,  and  cheers  the  mind.  Exercise,  to 
be  beneficial,  should  be  employed  in  such  a  manner  as 
to  bring  all  of  the  muscles  into  moderate  and  agreea 
ble  action,  and  as  a  pleasant  recreation,  rather  than  a 
necessary  task.  By  this  means  the  organism  is 
strengthened,  the  circulation  equalized,  the  "blue- 
devils"  exorcised,  and  the  pulmonary  organs  placed  in 
the  best  possible  condition  to  recover  themselves. 

In  pursuing  this  course  of  physical  exercise,  regard 
should  also  be  had  to  those  gymnastic  and  other  sports 
which  tend  to  expand  and  strengthen  the  thorax.  Too 
much  cannot  be  said  with  reference  to  the  importance 
of  this  subject,  also  the  erect  position  of  the  body,  and 
the  habitual  custom  of  taking  deep  and  free  inspira 
tions;  for  the  muscles  of  the  chest,  as  well  as  of  other 
parts  of  the  body,  waste  away  and  become  enervated, 
without  constant  exercise  in  a  natural  manner. 

In  connection  with  this  course,  we  must  strongly 
advise  the  frequent  use  of  breathing  tubes.  Having 
experienced  decided  benefit  in  our  own  person  from 
the  employment  of  this  kind  of  exercise  of  the  lungs, 
and  having  often  seen  it  adopted  by  others  with  prompt 
and  marked  advantage,  we  speak  confidently  of  its 
efficacy  in  debility  of  the  pulmonary  organs. 

Third,  persons  of  a  consumptive  habit  should  make 
use  of  highly  nutritious  food.  The  articles  which 
are  particularly  to  be  avoided,  arepor/r,  in  all  its 
diversified  forms,  as  ham,  sausages,  lard,  &c.,  all  fish 
not  having  scales,  like  eels,  catfish,  clams,  crabs,  lob 
sters,  &c.,  and  oily  and  greasy  food  generally. 

How  far  a  free  use  of  pork  may  exert  an  influence 
in  generating  tubercles,  we  know  not,  but  the  follow 
ing  fact  is  not  without  significance,  viz.  :  The  Jews 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  355 

and  all  other  tribes  and  nations  that  are  prohibited 
by  their  religion  from  using  the  swine  as  an  article  of 
food,  are  almost  uniformly  exempt  from  scrofula  and 
consumption.  The  very  common  occurrence  of  tuber 
culous  formations  in  this  filthy  animal,  would  seem  to 
be  presumptive  evidence  that  it  is  peculiarly  subject 
to  scrofula.  We  commend  therefore  to  the  consump 
tive  a  strict  adherence  to  the  dietetic  regulations 
which  were  advised  by  Moses  of  old  to  his  brethren, 
the  Hebrews,  as  being  most  conducive  to  health  and 
longevity. 

Fourth,  as  an  important  means  for  promoting  a 
healthy  action  of  the  skin,  and  equalizing  the  cir 
culation,  too  much  cannot  be  written  in  praise  of  ex 
ternal  applications  of  cold  water.  These  applications 
should  be  employed  daily,  either  in  the  form  of  baths, 
sponging,  or  the  wet  sheets  ;  in  many  instances  the 
greatest  service  will  be  derived  from  using  cold  water 
applications  to  the  chest  in  such  a  manner  as  to  bring 
out  an  eruption. 

The  effect  of  this  remedy  is  to  impart  tone  and 
vigour  to  the  cutaneous  structures,  and  to  allay  in  a 
decided  manner  nervous  irritation. 

Fifth,  another  valuable  preventive,  as  well  as  reme 
dial  agent  in  lung  affections,  consists  in  the  cultiva 
tion  of  a  cheerful  and  happy  disposition.  The  invalid 
must  never  brood  over  his  ailments,  for  by  gloomy 
ponderings  upon  his  case,  he  is  quite  prone  to  exagge 
rate  symptoms,  imagine  complaints  which  have  no 
existence,  and  thus  detract  from  his  prospect  of  re 
covery. 

Laennec  ranks  the  depressing  emotions  as  one  of 
the  most  prominent  accidental  causes  of  phthisis,  and 
we  are  quite  satisfied  that  he  has  not  over-estimated 
their  importance. 

Sixth,  (and  finally),  we  commend  a  strict  avoidance 
of  all  excesses,  whether  in  the  pleasures  of  the  table, 
wine,  and  liquors,  or  in  the  indulgence  of  any  thing 
which  over-stimulates  and  fatigues  mind  or  body. 

In  conjunction  with  the  above  measures,  some  one 
of  the  following  medicines  may  be  occasionally  ex 
hibited  with  benefit ;  making  the  selection,  of  course, 
according  to  the  peculiar  character  of  the  indications 


356  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

which  may  be  present,  viz.  :  ol.  jecoris  aselli,  sulphur, 
hepar  sulph.,  calcarea  carb.,  mercurius,  stannum,  ferrum, 
silicea,  sepia,  phosphorus,  acid  phos.,  acid  nit.,  lycopo- 
dium,  lachesis,  iodine,  iod.  potassce,  arnica,  belladonna, 
sambucus  and  china.  Of  these  medicines  the  oleum 
jecoris  aselli  is  probably  the  most  valuable,  and  should 
receive  more  attention  from  the  advocates  of  homoeo 
pathy  than  it  has  hitherto  done.  Holding  its  active 
principle,  iodine,  in  a  most  excellent  state  of  attenua 
tion,  the  infinitesimal  atoms  of  the  drug  with  its  oily 
vehicle  are  absorbed  and  conveyed  to  the  lungs,  where 
the  most  happy  curative  effects  are  often  produced. 
We  think  the  point  clear,  that  iodine  is  the  only  real 
curative  agent  in  these  cases ;  although  it  is  by  no 
means  improbable  that  its  medium,  the  animal  oil, 
which  is  composed  principally  of  carbon  and  hydrogen, 
may  serve  the  purpose  of  neutralizing  a  portion  of  the 
inspired  oxygen,  which  would  otherwise  act  upon  the 
weakened  lungs  themselves.  In  administering  this 
medicine,  therefore,  let  it  be  borne  in  mind,  that  the  oil 
is  not  the  medicinal  agent,  but  the  mere  vehicle  by 
means  of  which  the  real  remedy,  iodine,  is  introduced 
into  the  system.  Two  drachms  of  the  oil  may  be  pre 
scribed  three  or  four  times  daily. 

Sulphur  and  hepar  sulphur,  should  always  be  selected 
when  the  pulmonary  affection  can  be  clearly  traced  to 
abruptly  suppressed  psora,  whatever  may  be  the  gen 
eral  character  of  the  symptoms.  If,  however,  symp 
toms  are  present  which  point  strongly  to  some  other 
medicine,  an  alternation  may  be  resorted  to.  • 

Consumption  occasionally  arises  in  those  whose 
lungs  are  naturally  weak  and  irritable,  in  consequence 
of  violent  and  protracted  syphilitic  attacks.  In  these 
instances,  the  most  suitable  remedies  are  mercurius, 
acid  nit.,  potassce  iodide,  and  hepar  sulphur. 

When  phthisis  is  threatened  during  the  progress  of 
chlorosis,  or  in  consequence  of  masturbation,  or  exces 
sive  venery,  the  appropriate  medicines  are, phosphorus, 
acid  phosph.,  calcarea  carb.,  china,  silicea,  and  ferrum. 

For  uncomplicated  scrofulous  consumption,  our  most 
reliable  remedies  are,  unquestionably,  oleum  jecoris 
aselli,  calcarea  carb.,  iodine,  sulphur,  hepar  sulphur., 
sepia,  lachesis,  phosphorus,  and  silicea. 


DISEASES    OF    THE    RESPIRATORY    ORGANS.  357 

Administration. — The  first,  second,  and  third  at 
tenuations  are  most  efficient  in  all  stages  of  phthisis — 
the  doses  to  be  repeated  from  two  to  four  times  in 
twenty-four  hours,  until  the  required  specific  impres 
sion  is  produced. 

It  is  to  be  regretted  that  as  yet  so  few  positive  spe 
cifics  have  been  discovered  for  the  cure  of  tubercular 
phthisis,  but  we  are  sanguine  in  the  belief  that  many 
such  remedies  will,  sooner  or  later,  be  found.  In  the 
meantime  let  us  be  on  the  alert  to  attain  these  much 
coveted  desiderata. 

SECTION  IX. 

COUGH. 

In  most  instances,  cough  is  one  of  the  symptoms  of 
inflammatory  action,  either  of  the  parenchyma  of  the 
lungs,  or  of  some  membrane  connected  with  the  re 
spiratory  organs  ;  but  coughs  occasionally  arise  and 
reduce  the  patient  to  a  very  low  state  of  hectic  fever, 
without  the  presence  of  any  inflammatory  action,  ex 
cept  that  which  is  produced  by  the  act  of  coughing, 
from  an  elongation  and  relaxation  of  the  uvula,  from 
the  pressure  of  tumours  and  swellings  in  the  throat, 
trachea,  or  thorax,  from  hypertrophy  and  other  organic 
affections  of  the  heart, -and  from  accumulations  of  se 
rum  or  pus  within  the  thorax. 

We  have  in  several  instances  speedily  succeeded  in 
removing  troublesome  coughs,  and  of  restoring  patients 
to  health,  who  were  apparently  in  the  last  stages  of  pul 
monary  consumption,  by  clipping  off*  a  portion  of  an 
elongated  uvula.  It  is  not  uncommon  that  protracted 
and  troublesome  coughs  are  promptly  cured  by  the 
removal  of  tumours  in  the  neck,  by  the  puncturing  of 
abscesses  in  the  throat  or  chest,  or  by  evacuating  from 
the  thorax  an  effused  fluid.  It  behooves  us,  therefore, 
in  all  cases  of  cough,  where  the  cause  is  not  perfectly 
apparent,  to  make  our  investigations  with  reference 
to  the  above  enumerated  complications,  in  order  that 
surgical  measures  may  be  resorted  to  on  all  suitable 
occasions. 

It  is  to  be  feared  that  errors  are  sometimes  commit 
ted  by  gentlemen  of  our  school,  in  underrating  the 


358  DISEASES    OF    THE    RESPIRATORY    ORGANS. 

value  and  importance  of  surgery,  as  a  means  of  cur 
ing  disease.  When  the  cause  is  of  such  a  nature  that 
our  remedies  are  at  best  slow  and  uncertain,  while  a 
speedy  and  safe  removal  may  be  effected  by  a  surgi 
cal  operation,  we  should  never  hesitate  in  our  choice. 
Even  in  cases  like  paracentesis  abdominalis.  or  para- 
centesis  thorasis,  where  only  a  troublesome  symptom 
is  removed,  we  often  accomplish  much  good  by  plac 
ing  the  patient  in  the  best  possible  condition  for  the 
favourable  operation  of  remedial  agents.  But  in  the 
examples  of  obstinate  tumours  and  abscesses,  pressing 
unduly  upon  some  part  of  the  respiratory  apparatus, 
the  aid  of  the  surgeon  is  often  indispensable. 

Many  individuals  are  troubled  with  coughs  in 
temperate  latitudes  from  an  inherent  debility  of  the 
lungs,  and  a  wrant  of  vigour  to  resist  the  stimulating 
influence  of  cold  air.  Such  persons  often  succumb 
eventually  from  phthisis,  without  having  experienced 
any  actual  inflammation  of  the  pulmonary  structure. 

Others,  from  excesses  of  various  kinds,  acquire  a  pre 
disposition  to  coughs,  from  the  most  trivial  exciting 
causes. 

Therapeutics. — Appropriate  medicines  for  all  ordi 
nary  kinds  of  cough,  may  be  selected  from  those  already 
referred  to,  when  treating  of  the  different  affections  of 
the  respiratory  organs. 


359 


CHAPTER  XXIV. 

DISEASES  OF  THE  HEART  AKD  ITS  APPENDAGES, 

THE  heart  and  its  appendages  are  subject  to  several 
kinds  of  morbid  action,  which  authors  have  described 
under  the  terms  angina  pectoris,  hypertrophy,  and  dila 
tation  of  the  heart,  diseases  of  the  valves,  carditis,  and 
pericarditis,  and  palpitation.  Many  of  the  symptoms 
of  these  affections  are  similar,  but  we  shall  endeavour, 
in  the  following  brief  description,  to  point  out  a  suffi 
cient  number  of  signs  to  enable  the  physician  to  form 
a  ready  and  accurate  diagnosis  in  all  cases. 

SECTION  I. 

ANGINA     PECTORIS. 

Diagnosis. — At  the  commencement  of  the  disease, 
the  patient  experiences  occasional  sharp  pains  in  the 
region  of  the  heart,  especially  after  active  exercise, 
or  when  putting  the  muscles  of  the  chest  upon  the 
stretch.  After  a  time,  the  pains  recur  more  frequently, 
continue  for  a  longer  period,  and  are  accompanied  by 
palpitation,  attacks  of  syncope,  sense  of  suffocation-, 
and  tightness  in  the  chest,  and  great  difficulty  of 
breathing.  The  attacks  are  usually  excited  by  violent 
physical  exertions,  mental  emotions,  and  deranged 
stomach,  from  abuse  of  stimulants  and  of  indigestible 
food.  In  very  severe  cases,  there  are  almost  constant 
dyspncea,  pains  extending  down  the  arms  and  into  the 
back,  very  frequent  and  alarming  attacks  of  syncope 
and  suffocation,  pale  and  haggard,  or  livid  and  exceed 
ingly  anxious  expression  of  countenance.  If  the  dis 
ease  is  not  arrested,  the  patient  generally  expires  sud 
denly  in  one  of  these  distressing  paroxysms. 

When  angina  pectoris  proceeds  from  hypertrophy  of 
the  heart,  we  shall  observe,  in  addition  to  the  symp 
toms  just  named,  powerful  pulsations  of  the  heart, 
which  are  visible  at  a  distance,  full  and  vibrating 
pulse,  and  dull  sound  on  percussion. 

If  the  disorder  has  arisen  from  dilatation  of  tlte  ven- 


360       DISEASES    OF    THE    HEART    AND    ITS   APPENDAGES. 

trides,  there  will  be  swelling  and  visible  pulsation  of 
the  jugular  veins,  a  loud  and  distinct  sound  on  apply 
ing  the  ear  over  the  fifth  and  sixth  ribs,  vertigo,  fre 
quent  turns  of  syncope,  palpitation  and  dyspnoea,  pulse 
weak  and  tremulous. 

When  angina  pectoris  is  connected  with  disease  of 
the  valves  of  the  heart,  the  following  signs  will  be  pre-. 
sent :  great  dyspnoea  on  the  slightest  exertion,  frequent 
and  violent  palpitations,  pulse  feeble  and  irregular, 
livid  and  unnatural  appearance  of  the  countenance, 
oedematous  swelling  of  the  feet  and  ancles,  and  "  a 
permanent  sawing  or  rasping,  or  filing  sound  over  the 
valves  of  the  heart,  especially  after  depletion  and 
rest."— (Swett.) 

Causes. — Angina  pectoris  may  proceed  from  some 
organic  disease  connected  with  the  heart,  like  ossifica 
tion  of  the  coronary  arteries,  or  of  the  valves  of  the 
heart,  dilatation  or  hypertrophy  of  the  heart,  obstruct 
ed  circulation  from  an  accumulation  of  fat  about  the 
organ,  from  the  pressure  of  the  tumours,  or  from  asth 
ma.  Very  often,  however,  it  is  a  purely  sympathetic 
affection,  and  entirely  disconnected  with  any  struc 
tural  disorder  of  the  heart  or  its  appendages.  In  these 
instances,  the  nerves  which  supply  the  heart  are  af 
fected  in  such  a  manner  that  slight  exciting  causes, 
as  errors  in  diet,  mental  emotions,  or  ascending  a  flight 
of  stairs,  induce  the  paroxysms. 

Therapeutics. — In  the  selection  of  remedies,  strict 
regard  should  be  had  to  the  remote  and  exciting 
causes  of  each  case.  If  the  symptoms  are  the  result 
of  some  organic  affection  of  the  heart,  like  those  to 
which  we  have  alluded,  our  prognosis  must  be,  for 
the  most  part,  unfavourable,  and  we  can  only  reason 
ably  expect  to  palliate  the  sufferings  of  the  patient. 
But  if  the  remote  cause  consists  simply  of  a  diseased 
condition  of  the  par  vagum,  or  of  the  cardiac  nerves, 
which  renders  them  liable  to  become  morbidly  excited 
from  trivial  causes,  we  may  prescribe  medicines  with 
every  prospect  of  ultimate  success.  The  most  reliable 
specifics  in  this  malady,  are  aconite,  digitalis,  hepar 
sulphuris,  lachesis,  nux  vom.,  veratrum,  sepia,  sambucus, 
ipecacuanha,  pulsatilla,  arsenicum,  aurum. 

The  attenuations  should  be  selected  with  reference 


DISEASES    OF  THE    HEART    AND    ITS    APPENDAGKS.       361 

to  the  impressibility  of  the  patient,  and  the  medicine 
persisted  in,  at  suitable  intervals,  during  the  continu 
ance  of  the  complaint. 

SECTION  II. 

CARDITIS    AND    PERICARDITIS. 

Diagnosis. — Inflammation  of  the  fleshy  substance  of 
the  heart,  uncomplicated  by  disease  of  the  pericardium, 
of  the  pleura,  or  of  the  aorta,  is  an  occurrence  so  rarely 
met  with,  that  some  authors  have  described  under  one 
general  head,  the  symptoms  resulting  from  inflamma 
tions  of  the  heart  and  its  appendages.  The  signs 
usually  present  in  carditis,  often  render  our  diagnosis 
very  obscure,  on  account  of  their  resemblance  to  affec 
tions  of  the  lungs,  and  of  the  pleura,  and  of  their  fre 
quent  complication  with  the  latter.  Frank  believes 
that  much  of  the  uncertainty  which  prevails  respecting 
cardiac  affections,  is  attributable  to  the  general  ne 
glect  of  the  profession  in  investigating  the  movements 
of  the  heart  during  disease,  and  in  examining  its  mor 
bid  appearances  in  those  who  have  died  in  consequence 
of  diseases  of  the  chest.  "  II  n'est  pas  douteux  que,  si 
les  hommes  de  1'art  observaient  avec  la  meme  attention 
les  mouvements  et  les  vibrations  du  cc&ur  que  les  batte- 
ments  des  arteres,  s'ils  multipliaient  leurs  recherclies  sur 
les  cadavres,  Us  viendraient  a  bout  de  dissiper  les 
epaisses  tenebres  qui  environnent  les  maladies  de  Vorgane 
central  dc  la  circulation" — (Frank.) 

The  ordinary  symptoms  of  inflammation  of  the  heart 
and  its  envelop,  the  pericardium,  are  acute  pains  in  the 
region  of  the  heart,  increased  by  motion,  or  on  assuming 
the  horizontal  posture,  sense  of  fulness  and  oppression 
in  the  chest,  palpitation,  from  the  slightest  exertion,  or 
from  mental  excitement ;  rapid,  difficult,  and  irregular 
respiration;  short,  dry,  spasmodic  cough  ;  rapid,  small, 
irregular,  and  intermittent  pulsations  of  the  heart  and 
arteries ;  great  anxiety,  dread  of  suffocation,  "  absence 
of  the  respiratory  murmur,  and  dull  sound  on  percus 
sion." — (Hall.)  General  febrile  disturbance  almost 
always  accompanies  the  inflammation,  although  the 
heat  is  unequally  distributed,  some  parts  being  in 
tensely  hot,  while  other  parts  are  cold.  The  counte- 

16 


362       DISEASES    OF    THE    HEART   AND    ITS    APPENDAGES. 

nance  is  always  expressive  of  anxiety  and  distress,  the 
patient  is  desponding,  irritable,  and  restless,  and  ex 
periences  alarming  palpitations,  faintness  on  rising  up 
in  bed,  or  on  talking. 

Causes. — Protracted  grief,  anxiety,  or  mortification, 
violent  muscular  efforts,  external  injuries,  asthmatic, 
and  other  pulmonary  affections,  metastases  of  rheuma 
tism,  or  gout. 

Therapeutics. — Digitalis,  aconite,  bryonia,  arnica, 
cannabis,  pulsatilla,  lachesis,  spigelia,  iodine,  and  arseni- 
cum,  are  the  medicines  commonly  employed  in  this 
malady. 

Digitalis,  on  account  of  its  specific  power  over  the 
sympathetic  nerve,  and  the  cardiac  plexus,  is  especially 
adapted  to  those  cases  of  pericarditis  which  have 
been  caused  by  violent  emotions,  and  protracted  grief, 
care,  and  anxiety.  The  special  indications  are,  sharp 
stitches,  or  contractive  pains  in  the  region  of  the 
heart ;  uneasy  sensations  in  the  left  side  of  the  chest, 
often  extending  to  the  shoulder  and  arm  ;  palpitations 
excited,  by  talking,  movement,  or  on  laying  down, 
particularly  on  the  left  side  ;  pulse  rapid,  weak,  and 
irregular,  or  slow,  soft,  and  intermittent ;  sense  of  op 
pression  and  anguish  in  the  thorax  ;  general  weakness  ; 
frequent  attacks  of  faintness  ;  respiration  slow,  diffi 
cult,  and  unsatisfactory,  or  short,  painful  and  sighing; 
frequent  flushes  of  heat  in  the  chest,  face,  and  head, 
while  the  extremities  remain  cold  ;  general  feeling  of 
anxiety  and  despondency.  A  drop  of  the  second  or 
third  dilution  should  be  prescribed,  in  \vater,  every  two 
hours. 

Aconite  is  a  suitable  remedy,  when  the  movements 
of  the  heart  and  arteries  are  more  rapid  and  vigorous 
than  in  health,  and  when  the  congestion  to  the  heart 
is  accompanied  by  an  unusual  degree  of  erethism. 
The  pains  in  the  cardiac  region  are  of  a  constrictive, 
oppressive  or  lancinating  character  ;  the  breathing  is 
short,  anxious,  and  laboured  ;  the  pulse  is  rapid,  strong, 
and  intermittent  ;  the  action  of  the  heart  is  exalted, 
and  often  irregular  ;  febrile  symptoms  are  strongly 
pronounced  ;  the  patient  inclines  to  sit  with  his  body 
bent  forward,  in  order  to  relax  the  muscles  of  the 
thorax,  and  thus  to  obviate  the  liability  of  pain  from 


DISEASES    OF    THE    HEART    AND    ITS    APPENDAGES.       363 

this  cause.  The  first  or  second  dilution  of  aconite  may 
be  selected,  and  a  single  drop  administered  in  water, 
every  two,  three,  or  four  hours,  as  the  nature  of  the 
case  demands. 

Bryonia  will  occasionally  be  required,  in  inflamma 
tions  of  the  heart  and  its  appendages,  which  are  com 
plicated  by  disorder  of  the  pulmonary  structures.  It 
will  likewise  prove  serviceable  in  cases  which  are  con 
nected  with  rheumatism  or  gout.  The  following  are 
its  indications :  drawing  and  stitching  pains  in  the 
chest,  aggravated  by  breathing,  or  by  movement ;  rap 
id,  anxious,  and  painful  respiration ;  dry,  spasmodic, 
and  painful  cough ;  lancinating  pains  extending  into 
the  shoulders  and  back,  between  the  shoulder-blades ; 
oppression  in  the  chest,  which  causes  frequent  sighing  ; 
determinations  of  blood  to  the  chest,  and  head  ;  rapid, 
weak,  and  intermittent  pulse  ;  anxious,  depressed,  and 
irritable.  Its  administration  is  the  same  as  aconite. 

Arnica  is  chiefly  useful  when  the  inflammation  has 
been  caused  by  external  injuries,  like  contusions, 
wounds,  &c.  The  special  indications  are,  lancinating 
pains  in  the  region  of  the  heart  ;  oppression  at  the 
chest ;  great  difficulty  of  breathing ;  short,  dry,  and 
irritating  cough  ;  sharp  pains  through  the  heart,  which 
cause  faintness  ;  irregular  action  of  the  heart ;  pains, 
and  dyspnoea,  increased  by  mental  or  physical  exertion. 
It  may  be  given  the  same  as  aconite. 

Cannabis,  pulsatilla,  lachesis,  iodine,  and  arsenicum, 
have  been  employed  with  success,  in  cardiac  inflam 
mations  which  have,  arisen  from  suppression  of  erup 
tions,  or  the  drying  up  of  old  ulcers.  They  may  be  used 
at  the  second  or  third  attenuations — the  repetitions  of 
doses  to  be  governed  by  the  urgency  of  the  symptoms, 
and  the  medicinal  or  other  effects  produced. 

Should  the  disease  terminate  in  dropsy  of  the  peri 
cardium,  our  best  remedies  are,  arsenicum,  apis  meL 
and  iodine.  We  prefer  the  first  or  second  attenuations 
— a  dose  once  in  six  hours  until  an  impression  is 
evident. 


364 
CHAPTER  XXV. 

DISEASES  OF  THE  BRAIN  AND  NERVOUS  SYSTEM. 
SECTION  I. 

GENERAL    OBSERVATIONS. 

IF  the  soul  of  man  manifests  itself  through  the 
healthy  organism  in  a  certain  definite  manner,  and 
if  these  manifestations  are  modified  precisely  in  ac 
cordance  with  the  abnormal  conditions  which  the  or 
gans  and  tissues  may  acquire,  the  importance  of  a  cor 
rect  understanding  of  the  exact  healthy  functions  of 
all  the  structures,  and  of  their  alterations  during  dis 
ease,  will  be  duly  appreciated.  Unfortunately  for 
science,  the  profusion  of  hypotheses,  the  arbitrary  as 
sumption  of  ancient  ideas  for  facts,  as  well  as  the  in 
herent  difficulties  attending  the  pathology  of  diseases 
of  the  cerebro-spinal  system,  have  until  recently  re 
tarded  the  onward  progress  relative  to  their  nature 
and  treatment.  Until  Sir  Charles  Bell  demonstrated 
that  the  nerves  which  arise  from  the  posterior  column 
of  the  spinal  marrow  were  devoted  to  sensation ;  those 
from  its  anterior  column,  to  muscular  contraction  ; 
while  the  middle  column  gives  origin  to  the  respiratory 
nerves,  the  most  erroneous  and  contradictory  notions 
were  entertained  respecting  the  functions  and  diseases 
of  the  nervous  system. 

Majendie,  Flourens.  Abercrombie,  Hall,  Solly,  Ser- 
res,  Bennett  and  Andral  have  also  thrown  much  light 
upon  the  functions  of  particular  portions  of  the  brain  ; 
but  much  yet  remains  to  be  done  in  this  important 
field  of  discovery,  and  it  is  only*  by  banishing  from 
our  medical  vocabulary  all  vague  and  obscure  ex 
pressions,  and  contemplating  the  body  as  a  complica 
ted  machine,  actuated  and  kept  in  operation  by  an  in 
telligence  which  pervades  every  part,  and  in  conjunc 
tion  with  its  material  stimuli,  giving  rise  to  sight  in 
the  organ  of  sight, — hearing,  taste,  smell,  digestion, 
assimilation,  calorification,  motion,  &c.,  in  their  several 
organs  ; — and  perceptions,  memory,  comparisons  and 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.       365 

ratiocination,  by  their  operation  upon  a  combination 
of  organs,  that  we  can  arrive  at  accurate  conclusions. 

The  cerebral  organs  may  be  affected  throughout 
their  whole  extent,  or  in  isolated  parts  alone  ;  but 
whatever  condition  obtains,  diseases  of  certain  sections 
of  the  cranium  usually  give  rise  to  peculiar  and  well 
defined  symptoms.  Thus,  compression  of  the  brain, 
whether  from  effused  blood,  serum  or  pus,  depression  of 
a  portion  of  the  cranium,  or  a  congested  and  relaxed 
condition  of  the  cerebral  vessels,  give  rise  to  coma, 
with  slow  pulse  and  stertorous  respiration  :  organic 
lesions  of  the  brain,  to  paralysis  of  one  or  more  parts 
of  the  body,  depending  upon  the  extent  of  the  lesion 
and  the  part  affected  :  irritation  of  the  brain,  to  con 
vulsions  :  disease  of  the  cortical  substance  or  hemi 
spherical  ganglia,  to  delirium  and  mania :  of  the  medul 
lary  or  tubular  structure,  to  convulsions  :  effusion  with 
in  the  ventricles,  to  dementia :  effusion  upon  the  sur 
face  of  the  brain,  to  lethargy  :  inflammation  of  either 
lateral  lobe  of  the  cerebellum,  to  paralysis  of  the  lower 
extremity  of  the  opposite  side:  inflammation  of  the 
middle  lobe,  to  erection  of  the  penis,  (Hall :)  of  the 
arachnoid  and  pia-mater,  to  delirium :  ramollissement,  to 
torpor  of  the  intellectual  faculties  and  loss  of  muscular 
power. 

So  strongly  marked  are  these  signs,  that  pathologists 
have  made  somewhat  minute  classifications  of  the  dis 
eases  of  the  brain,  as  of  the  arachnoid,  of  the  pia-mater, 
of  the  cortical,  or  the  medullary  part,  the  base,  the  tuber- 
annulare,  the  hemispheres  and  the  cerebellum.  But  it 
is  to  be  observed  in  most  cerebral  affections,  that  in 
flammations  of  particular  structures  rarely  exist  un 
complicated  with  more  or  less  disease  of  the  surround 
ing  parts,  and  on  this  account  we  meet  with  a  great 
diversity  of  symptoms  during  their  progress.  For  this 
reason,  if  no  other,  it  is  more  consistent  to  prescribe 
for  the  totality  of  the  symptoms  than  for  the  mere  name 
of  the  disease.  By  the  former  course  we  pursue  a  de 
finite  object,  and  apply  our  remedies  with  an  assurance 
of  success,  even  if  we  are  in  error  respecting  the  pa 
thology  of  the  case  ;  while  by  the  latter  method,  we 
are  liable  to  mistake  the  location  and  nature  of  the 
malady,  and  thus  adopt  a  pernicious  mode  of  practice. 


366   DISEASES  OF  THE  BRAIN  AND  NERVOUS  SYSTEM. 

For  example,  by  mistaking  the  cerebral  symptoms  of 
a  typhus  fever  for  encephalitis,  or  the  ancsmic  condi 
tion  of  the  brain  which  obtains  in  true  delirium  tre- 
mens,  in  some  cases  of  apoplexy,  in  epilepsy,  and  in 
ramollissement,  for  acute  inflammation,  and  resorting  to 
the  usual  remedies  for  the  cure  of  the  latter,  viz.  : 
copious  venesections,  the  most  disastrous  results 
might  be  apprehended.  It  is  now  a  well-ascertained 
fact,  that  delirium,  coma,  hydrocephalus,  and  one  form 
of  ramollissement,  may  result  from  an  ancemic,  as  well 
as  an  inflammatory  condition  of  the  brain.  Drs.  Aber- 
crombie  and  Marshall  Hall  recognise  still  another 
comatose  condition  independent  of  disease  of  the  brain, 
and  arising  from  exhaustion  of  the  general  system  oc 
curring  during  the  last  stages  of  certain  diseases  ;  but 
from  the  fact  that  this  coma  generally  occurs  after 
protracted  bowel  complaints  where  opium  has  been 
used  as  the  principal  remedy,  we  are  of  opinion  that  a 
real  cerebral  disease  has  been  superinduced  by  the 
remedy. 

For  the  cure  of  the  symptoms  above  named,  arising 
from  an  ancsmic  condition  of  the  brain,  tonics,  stimu 
lants  and  a  nutritious  regimen  are  deemed  essential  by 
the  practitioners  of  the  old  school.  Blood-letting  and 
antiphlogistics  in  these  cases,  are  fatal.  But  when 
the  same  symptoms  arise  from  an  inflammatory  con 
dition  of  the  encephalon,  a  treatment  directly  the  re 
verse,  is  supposed  to  be  necessary  to  save  life,  like 
venesection,  leeching,  purging,  blisters,  &c.  Now 
when  we  contemplate  the  great  uncertainty  attending 
the  diagnosis  in  these  two  forms  of  disease,  and  the 
danger  which  must  attend  mistakes  in  treatment  ori 
ginating  from  errors  respecting  the  peculiar  condition 
of  the  brain,  is  it  strange  that  people  have  no  more 
confidence  in  allopathy  ? 

We  have  before  remarked,  that  morbific  substances, 
in  order  to  develop  diseased  action  in  the  organism, 
must  be  taken  into  the  blood  and  conveyed  to  those 
tissues  upon  which  they  exert  a  specific  morbific  in 
fluence,  there  producing  those  alterations  (probably 
upon  the  sentient  extremities  of  the  nerves)  which  con 
stitute  disease.  It  is  only  necessary  to  refer  to  the 
axamples  to  which  we  have  alluded  in  another  part 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      367 

of  this  work,  to  render  this  supposition  entirely  proba 
ble. 

It  is  also  equally  evident,  from  the  multitude  of  ex 
periments  by  Miiller,  Majendie,  Orfila,  Pereira,  Hah- 
nemann,  Trinks,  Philips,  Flourens,  and  Bichat,  that 
poisonous  drugs  and  all  medicinal  substances  operate 
in  the  same  manner  in  producing  their  specific  poison 
ous  or  medicinal  effects. 

There  are  other  causes  constantly  operating  upon 
the  system,  of  a  character  entirely  different  from  those 
to  which  allusion  has  just  been  made,  and  which  may 
with  propriety  be  termed  spiritual  or  dynamic.  Thus, 
violent  mental  disturbance  may  cause  epilepsy  or  apo 
plexy — chagrin  and  grief,  biliary  derangements,  jaun 
dice,  and  dyspepsia — sudden  news,  whether  good  or 
bad,  diarrhoea — anger,  fear,  disappointment,  and  ill 
news,  sometimes  instantly  destroy  the  appetite  ;  fear 
and  apprehension,  predispose  to  contagious  disorders ; 
the  sight  of  blood  induces  syncope  ;  and  of  human  suf 
fering,  pain  and  disorder  in  the  stomach.  In  these 
cases,  the  unusual  mental  excitement  determines  an 
unnatural  amount  of  blood  to  certain  parts,  the  blood 
vessels  and  nerves  of  such  parts  are  oppressed,  and 
disease  results.  ^ 

But  it  is  of  vast  importance  that  these  spiritual  or 
dynamic  causes  be  not  confounded  with  those  which 
are  material  and  imponderable.  Let  us  not  deceive 
ourselves  and  the  world,  by  classing  them  where  they 
do  not  belong,  simply  because  our  limited  knowledge 
of  the  sciences  renders  us  as  yet  incapable  of  appreci 
ating  the  nature  and  the  precise  mode  of  operation  of 
the  latter ! 

Although  cerebral  affections  may  arise  under  fa 
vourable  circumstances,  from  the  absorption  of  mor 
bific  and  medicinal  substances,  and  from  spiritual  or 
dynamic  influences,  yet  the  latter  rank  first  in  import 
ance,  especially  in  what  are  termed  chronic  cerebral 
maladies.  In  the  treatment  of  brain  diseases,  therefore, 
too  much  importance  cannot  be  attached  to  an  accu 
rate  knowledge  of  these  causes ;  for  it  is  only  by  their 
prompt  removal,  together  with  a  judicious  application 
of  remedial  agents,  that  we  can  expect  complete  suc 
cess. 


368      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

The  curious  reader  will  find  much  to  amuse,  if  not 
instruct,  by  tracing  the  medical  history  of  cerebral  ma 
ladies  from  Hippocrates  to  the  present  time.  Through 
out  all  of  this  period,  notwithstanding  the  numerous 
changes  of  opinion  respecting  their  nature,  causes,  &e.? 
one  striking  fact  will  always  be  observed,  viz. :  that 
the  treatment  for  all  of  these  complaints  has  remained 
almost  the  same  as  first  instituted  by  that  very  respect 
able  heathen  philosopher,  Hippocrates,  until  the  pe 
riod  of  Hahnemann. 

In  proof  of  the  singular  tenacity  with  which  the  med 
ical  world  has  clung  to  the  opinions  of  the  ancients, 
we  may  cite  the  doctrines  of  eminent  physicians  as 
late  as  the  time  of  Sydenham,  who  supposed  the  cause 
of  many  brain  diseases,  as  lethargy,  coma,  paralysis, 
&c.,  to  consist  in  a  "  viscid  condition  of  the  blood  and 
lymph,  which  obstructed  the  pores  of  the  brain,  and  dulled 
the  animal  spirits.  While  the  viscid  blood  forces  its  way 
into  the  brain,  through  the  two  carotids,  it  leaves  in  its 
passage  a  slimy  matter,  through  which  the  animal  spirits 
passing,  stick  by  the  way,  and  so  the  pores  of  the  brain 
are  obstructed.1' — (Sydenham  and  Salmon,  Prac.  Phys., 
p.  203.) 

Their  in<Jications  of  cure,  were  :  first,  "  to  evacuate 
the  redundancy  of  phlegm  and  choler,  or  to  carry  off  that 
vicious  acid  which  has  created  the  viscosity  of  the  blood. 
Second,' to  alter  the  present  dyscrasia  of  the  blood.  Third, 
to  open  the  pores  of  the  brain  now  obstructed,  and  give  a 
free  passage  to  the  spirits.  Fourth,  to  strengthen  the 
weakened  parts,  quicken  the  dull  spirits,  and  increase 
their  store  or  stock." — (Ibid.) 

To  fulfil  these  indications  of  cure,  the  fathers  of  al 
lopathy  adopted  almost  precisely  the  same  treatment 
as  that  which  prevails  with  their  brethren  of  the  pre 
sent  day,  viz. :  blood-letting,  emetics,  cathartics,  "  to 
purge  off  the  phlegm  and  choler,"  antimonials  and  alter 
atives,  "  to  cut  up  the  gross  phlegm,  dissolve  the  coagu- 
lums  of  the  blood  and  humours,  and  excite  the  animal 
spirits  to  a  brisker  and  more  lively  air."  Paracelsus 
and  Van  Helmont  particularly  commended  opiates  and 
narcotics  in  chronic  affections  of  the  brain.  If  we  re 
fer  to  the  most  recent  writers  on  insanity  and  other 
cerebral  affections,  we  shall  find  not  only  the  same 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      369 

remedies  retained,  but  the  same  diversity  of  opinions 
respecting  the  application  of  these  remedies  ;  some 
trusting  to  venesection  and  purges,  some  to  tonics, 
while  others  depend  upon  opiates  and  narcotics. 

In  a  book  which  is  now  before  me,  published  in  the 
year  of  our  Lord,  1587,  by  "Andrew  Boord,  Doctor  of 
Physic — an  Englishman,"  our  sapient  author  supposes 
that  maniacs  are  possessed  of  devils,  and  advises  for 
their  cure,  in  addition  to  blood-letting,  cathartics,  &c., 
that  they  should  be  sent  to  Rome  to  be  made  whole. 
"  For  within  the  precincts  of  St.  Peter's  Church,  without 
St.  Peter's  Chapel,  standeth  a  pillar  of  white  marble, 
grated  round  about  with  iron,  to  the  which  our  Lord 
Jesus  Christ  did  lie  in  himself  at  his  delivery  unto  Pi 
late,  as  the  Romans  doth  say,  to  the  which  "pillar,  all 
those  that  be  possessed  of  the  devil,  out  of  divers  coun 
tries  and  nations,  be  brought  thither,  and  as  they  say 
at  Rome,  such  persons  be  made  there  whole."  It  was 
a  matter  of  doubt,  however,  whether  the  pillar  or  the 
priest  (who  accompanies  the  patient  within  the  enclo 
sure)  effected  the  cure,  though  we  believe  the  weight 
of  argument  was  in  favour  of  the  priest. 

The  same  writer  supposes  the  cause  of  phrenitis  to 
consist  of  "  water  or  wind  enclosed  in  the  head,"  and 
the  remedies  were  "  to  purge  the  head  with  sternuta 
tories,  and  the  bowels  with  physic." 

Modern  pathologists  have  discovered  that  maniacs 
are  not  possessed  of  devils, — that  phrenitis  is  not  ow 
ing  to  "  wind  being  enclosed  in  the  head," — that  coma, 
lethargy,  and  paralysis,  are  not  caused  by  "  viscid 
blood  rushing  into  the  brain  through  the  two  carotids, 
and  leaving  in  its  passage  a  slimy  matter,  through 
which  the  animal  spirits  passing,  stick  by  the  way," 
but  they  have  demonstrated  that  inflammation,  irrita 
tion,  organic  lesion,  and  compression,  give  rise  to  the 
phenomena  which  characterize  the  different  diseases 
of  the  brain.  But  notwithstanding  this  change  of 
opinion  in  a  pathological  point  of  view,  the  therapeu 
tical  doctrines  remain  the  same  as  formerly,  with  the 
single  exception  of  advising  maniacs  to  be  sent  to  the 
marble  pillar  at  Rome. 

Blood-letting,  probably  to  let  out  the'"  slimy  "  part 
of  the  blood  :  emetics  and  purgatives,  to  "  purge  off 

16* 


370      DISEASES    OF"  THE    BRAIN    AND    NERVOUS    SYSTEM. 

the  phlegm  and  choler,"  irritating  and  inflaming  the 
intestinal  canal  in  order  to  cure  a  disease  located  in 
the  brain,  and  now  and  then  an  opiate  to  cover  up 
symptoms  when  too  troublesome,  are  still  resorted  to 
by  gentlemen  of  the  old  school. 

It  is  to  be  hoped  that  the  time  is  not  far  distant 
when  all  such  indirect  and  unreasonable  practices  for 
the  cure  of  diseases,  will  be  entirely  superseded  by 
the  more  direct  and  philosophical  method  of  treatment 
which  has  been  instituted  by  the  father  of  homcBO- 
pathia  and  his  disciples. 

Probably  in  no  class  of  maladies  has  allopathy  been 
so  much  at  fault  as  in  her  classification  of  cerebral" 
affections.  Each  author  who  has  written  upon  the 
subject,  has  taken  upon  himself  to  promulgate  patho 
logical  views  different  from  those  of  his  predecessors, 
and  from  these  views  to  form  new  classifications  and 
new  modes  of  treatment.  While  some  nosologists 
recognise  inflammations  of  the  arachnoid,  of  the  pia 
mater,  of  the  cineritious,  or  cortical  substance,  of  the 
medullary,  or  tubular  structure,  of  the  different  lobes 
of  the  cerebellum,  of  the  tuber-annulare,  &c«,  as  dis 
tinct  diseases,  requiring  different  modes  of  treatment; 
others,  as  Frank,*  describe  inflammation  of  the  hem 
ispheres  of  the  brain,  the  cerebellum,  and  their 
common  envelopes,  as  a  single  disease,  under  the 
general  term  encephalitis,  and  demanding  for  its  cure  a 
definite  course  of  treatment.  Thus,  "  L 'inflammation 
du  cerveau,  du  cervelet,  de  Icur  envcloppes  communes,  ne 
presente  pas,  selon  la  difference  de  son  siege,  des  symp- 
tomes  distinctifs  surs et  constants"  So  also  Solly,  in  his 
work  on  the  human  brain,  at  page  322,  remarks,  "  I 
have  long  felt  convinced  that  there  is  no  such  thing  as 
inflammation  of  the  pia  mater,  independent  of  the 
brain,  and  that  much  mischief  has  accrued  from  our 
systematic  writers  treating  of  inflammation  of  the 
membranes  of  the  brain  as  distinct  from  inflammation 
of  the  brain  itself,"  The  same  writer  lays  down  the 
following  broad  principles,  viz.,  **  that  inflammation  of 
the  brain  is  a  depressing  disease,  and  that,  as  a  gene 
ral  rule,  general  blood-letting  is  not  often  admissible. 

*  Traite  de  Medicine-pra  clique,  pnge  116. 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.       371 

That,  although  blood-letting  may  sometimes*  be  at 
tended  with  benefit  at  the  time,  the  good  derived  from 
it  is  seldom  permanent."  Again,  '*  //  n'existe  pas  de 
signes  certains  qui  annoncent  le  siege  de  Vencep  halite, 
qui  caracterisent  la  phlogose  superficielle  et  Finflamma- 
tion  phlegmoneuse  avec  tendance  a  la  suppuration,  Ces 
varietes  rfojfrent  pas  des  caracteres  dijferentiels  assez 
constants  pour  distinguer  la  frenesie  de  la  cephalite. 
L'invasion  subite  de  la  douleur,  la  violence  de  la  fievre, 
lastapeur  des  organes  des  sens  et  de  V  entendement, 
bientot  suivie  de  ^extinction  de  leurs  facultes,  ne  prou- 
ventpas  I'inflammationde  lapulpe  cerebrale. — (Frank)." 
In  view  of  these  radical  differences  of  opinion,  and 
from  the  generally  acknowledged  fact,  that  no  single 
structure  within  the  cranium  can  become  inflamed, 
without  involving  to  a  greater  or  less  extent  other 
portions  of  the  cerebral  region,  we  shall  adopt  the 
following  classification:  First,  encephalitis, embracing 
acute  inflammation  of  the  hemispheres,  the  cerebel 
lum,  and  their  membranes  ;  under  which  head  we 
shall  point  out,  as  clearly  as  possible,  the  peculiar 
symptoms  which  are  supposed  to  characterize  affec 
tions  of  these  different  parts.  Second,  the  diseases 
which  occasionally  result  from  encephalitis,  as  ra- 
mollissement,  hydrocephalus.  and  epilepsy.  Third,  apo 
plexy  and  paralysis.  Fourth,  delirium  tremens.  Fifth, 
insanity. 

SECTION    II. 

ENCEPHALITIS. 

Diagnosis. — There  are  certain  symptoms  which  are 
common  to  the  first  stages  of  all  acute  inflammations 
of  the  cerebral  organs  ;  and  which,  taken  by  them 
selves,  afford  no  indication  of  the  actual  seat  of  the 
disorder.  These  symptoms  are,  a  vague  sensation  of 
coldness  in  the  first  instance,  perhaps  succeeded  by 
occasional  flushes  of  heat,  lassitude,  anxiety,  sadness, 
irritability,  often  alternating  with  great  exaltation  of 
the  intellectual  faculties  ;  hilarity,  sudden  bursts  of 
laughter,  petulance,  unwonted  impudence  and  vul 
garity  ;  redness  of  the  skin,  heat,  pain,  pressure  or  ten 
sion  in  the  head  ;  strong  pulsations  of  the  carotid 


372       DISEASES    OF    THE    BRATN    AND    NERVOUS    SYSTEM. 

and  temporal  arteries ;  singing  noises  in  the  head, 
vertigo,  weakness  of  memory,  frightful  dreams,  fan 
tastic  visions  when  awake  ;  trembling  of  the  limbs, 
nausea,  vomiting  ;  eyes  bloodshot,  great  sensibility  to 
light ;  constant  wakefulness  ;  acuteness,  or  dulness  of 
hearing  ;  mouth  and  tongue  dry  ;  urine^copious,  yel 
low,  and  thin  as  water* 

The  symptoms  which  usually  obtain  in  the  second 
stages  of  these  aifections  are,  stupidity,  coma,  paraly 
sis,  eyes  suffused  and  dull,  besotted  expression  of 
countenance,  strabismus,  position  upon  the  back,  pu 
pils  dilated,  suppression  of  urine,  and  general  loss  of 
muscular  power. 

The  signs  which  are  supposed  to  be  peculiar  to  the 
first  stage  of  inflammation  of  the  cortical  substance, 
or  hemispherical  ganglion,  and  the  membranes  of  the 
brain,  are,  early  derangement  of  the  intellectual  facul 
ties,  fixed  pain  in  the  upper  part  of  the  head  ;  hot  and 
dry  skin,  conjunctiva  injected  and  red  ;  eyes  brilliant, 
ferocious,  fixed,  and  intolerant  to  light  ;  |  tone  rough, 
violent,  and  defiant ;  face  red  and  swollen  ;  inclination 
to  do  himself  or  others  injury ;  great  exaltation  of 
muscular  strength ;  strong  pulsations  of  the  carotid 
and  temporal  arteries ;  constant  wakefulness ;  con 
tinued  and  rapid  motions  of  the  head  ;  impatience,  irri 
tability,  and  constant  agitation. 

The  first  stage  of  inflammation  of  the  medullary 
substance  of  the  brain,  is  recognised  by  the  following 
symptoms :  vague  chills ;  deep-seated  headache,  or 
vertigo  ;  vomiting,  lassitude,  trembling  of  the  limbs  ; 
convulsions  before  any  signs  of  mental  disorder,  anxi 
ety,  sadness,  great  agitation,  arms  continually  raised 
towards  the  head,  position  mostly  upon  the  back, 
noises  in  the  head.  This  disease  is  so  insidious  in  its 
approach,  that  convulsions  may  occur  as  the  very  first 
symptom.  In  instances  like  this,  it  is  probable  that 
inflammation  exists  in  the  medullary  substance  alone, 
without  involving  in  the  slightest  degree  the  gray 
matter  of  the  convolutions  surrounding  this  part,  or 
the  envelopes  of  the  brain.  We  are  forced  to  this 
conclusion  if  we  adopt  the  opinions  of  Bouilland,  Solly, 
Duchatelet,  Hall,  and  Bennett,  who  suppose  the  cinr- 
rilious,  or  cortical  substance  of  the  brain,  to  be  "  im- 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.        373 

mediately  connected  with  the  intellectual  powers," 
while  the  medullary  portion  presides  over  the  muscu 
lar  powers  of  the  organism.  Therefore,  after  an  in 
jury  to  the  head,  if  the  intellect  is  only  impaired,  we 
may  be  certain  that  the  hemispherical  ganglion  is 
the  seat  of  the  injury,  while  if,  in  addition,  there  are 
involuntary  convulsive  motions  of  the  muscles  soon 
after  the  accident,  we  may  be  equally  sure  that  the 
medullary  substance  has  also  received  detriment. 

Inflammation  of  the  medullary  structure  is  more 
prone  than  either  of  the  other  cerebral  inflammations, 
to  terminate  rapidly  in  softening,  and  for  this  reason  it 
is  incumbent  upon  physicians  to  exercise  the  greatest 
care  in  their  investigations  of  this  class  of  maladies, 
and  to  apply  their  remedial  measures  with  due 
promptness. 

The  most  prominent  secondary  symptoms  of  disease 
of  this  portion  of  the  brain  are,  muscular  paralysis, 
and  loss  of  sensation  in  the  parts  affected. 

According  to  Marshal  Hall,  "  disease  of  a  lateral  lobe 
of  the  cerebellum  induces  paralysis  of  the  opposite 
side,  and  chiefly  of  the  lower  extremity.  Disease  of 
the  middle  lobe  of  the  cerebellum  is  denoted  by  erec 
tion  of  the  penis.  Disease  of  the  medulla  oblongata 
induces  paralysis  of  the  respiratory  muscles,  and  con 
sequently,  when  complete,  instant  death." 

We  have  now  enumerated  those  symptoms  which 
are  supposed  to  characterize  the  inflammations  of  the 
different  cerebral  structures,  and  in  this  connection, 
we  call  the  attention  of  homoeopathic  practitioners 
especially  to  this  subject,  with  reference  to  the  thera 
peutical  application  of  medicines.  Flourens  has  de 
monstrated,  by  experiments  upon  birds,  that  belladonna, 
opium,  and  alcohol,  uniformly  exercise  a  specific  ac 
tion  upon  certain  portions  of  the  brain.  Hahnemann 
and  his  disciples  have  also  proved  that  large  doses  of 
these  articles  taken  in  health,  uniformly  give  rise  to 
those  physical  and  mental  manifestations  which  pa- 
thologists  have  shown  to  proceed  from  disease  of  these 
same  parts.  When,  therefore,  in  our  provings  of 
drugs,  it  is  observed  that  the  prominent  symptoms  are, 
derangement  of  the  intellectual  faculties,  exaltation  of 
the  mental  and  muscular  powers,  eyes  bloodshot,  and 


374     DISEASES    OF    THE    BRAIN    AND    NERVOUS   SYSTEM. 

expression  furious  and  defiant,  manner  violent  and 
overbearing,  voice  loud  and  rough,  throbbing  pain  in 
the  head,  face  red  and  swollen,  we  may  be  certain 
that  a  specific  effect  has  been  produced  upon  the  cor 
tical  substance  of  the  brain.  If,  instead  of  these 
symptoms,  we  are  presented  with  convulsions,  pa 
ralysis,  and  general  depression  of  the  powers  of  the 
system,  we  may  infer  that  the  drug  has  acted  specifi 
cally  upon  the  medullary  portion  of  the  brain.  The 
same  law  obtains  in  relation  to  those  symptoms  which 
characterize  diseases  of  the  different  lobes  of  the 
cerebellum  of  the  medulla  oblongata,  of  the  different 
portions  of  the  spinal  marrow,  of  the  nerves,  and 
indeed  of  all  other  parts  of  the  organism. 

In  our  selection  of  remedies,  therefore,  we  should 
always  endeavour  to  choose  those  of  which  the  action 
has  been  shown,  by  pathological  facts,  as  well  as  by 
provings,  to  be  positively  specific  upon  the  structure 
affected. 

Causes. — Solly  has  very  justly  observed,  in  his  trea 
tise  on  the  human  brain,  that  "  there  is  no  single  cause 
which  so  frequently  produces  inflammation  of  the  hem 
ispherical  ganglion,  or  meningitis,  as  sudden  emotion, 
whether  of  joy  or  fear.  The  latter  is,  however,  much 
more  common."  Other  causes  are,  fractures  and  con 
tusions  of  the  cranium;  insufficient  sleep;  intense  and 
protracted  thought  upon  a  particular  subject,  disap 
pointed  love  or  ambition  ;  repelled  eruptions,  whether 
by  natural  causes  or  by  the  abuse  of  ointments ;  ex 
posure  to  cold,  or  to  a  burning  sun  ;  abuse  of  opium, 
and  spiritous  liquors  ;  metastases  of  rheumatism,  gout, 
or  erysipelas,  and  suppression  of  the  lochial  and  other 
habitual  discharges.  It  often  arises  during  the  progress 
of  pneumonia,  scarlatina,  erysipelas,  otitis,  and  bowel 
affections.  The  most  common  predisposing  causes 
are,  plethora,  a  passionate  and  excitable  disposition, 
want  of  exercise,  high  living,  and  abuse  of  stimulants. 

Therapeutics. — In  the  treatment  of  this  class  of  dis 
eases,  it  is  of  especial  importance  that  due  regard  be 
paid  to  the  causes  which  may  have  conduced  to  the 
attack.  An  encephalitis  which  has  followed  imme 
diately  upon  the  suppression  of  a  lochial  discharge, 
an  habitual  nasal  ha-morrhage,  or  the  retrocession  of 


DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM.      375 

an  eruption  by  improper  external  applications,  not 
only  requires  a  remedy  which  shall  cover  all  of  the 
manifest  symptoms,  but  one  which,  at  the  same  time, 
shall  operate  in  such  a  manner  as  to  bring  back  the 
original  discharge,  or  eruption.  If  disappointment, 
pecuniary  embarrassments,  fright,  or  political  or  re 
ligious  excitement,  has  been  the  exciting  cause,  the 
mind  of  the  patient  should  be  soothed  and  attracted 
into  new  and  agreeable  trains  of  thought.  By  these 
means  we  shall  prepare  the  organism  to  receive  our 
remedies  in  the  most  favourable  manner. 

The  principal  remedies  employed  in  encephalitis, 
are,  belladonna,  aconite,  opium,  hyoscyamus,  stramonium, 
moschus,  chamomela,  laurocerasus,  and  ignatia,  for  in 
flammation  of  the  medullary  substance  alone  :  mos~ 
elms,  plumbum,  acid  oxalic,  nux  vomica,  opium,  and 
oleander,  for  paralysis  :  rhus  rad.,  rhus  tox..  bryonia, 
and  belladonna,  for  metastasis,  or  extension  of  rheuma 
tism  to  the  brain :  spigelia,  cuprum  acetat.,  tartar 
emetic,  bryonia,  sulphur,  tabac.,  and  beJladonna,  when 
the  disease  has  arisen  in  consequence  of  repelled 
eruptions. 

Belladonna  will  be  required  when  the  disease  pre 
sents  itself  as  follows :  febrile  symptoms,  accompa 
nied  with  dry  ness  of  the  mouth,  tongue,  and  throat ; 
difficult  deglutition,  nausea,  vomiting;  confusion  of 
the  head;  giddiness;  dilatation  of  the  pupils;  injec 
tion  of  the  conjunctiva  ;  eyes  suffused,  brilliant,  fu 
rious,  and  protruded  ;  imperfect  vision  ;  gay  delirium  ; 
increased  secretion  of  urine,  and  frequent  desire  to 
evacuate  the  bladder  ;  heaviness,  pressure,  or  throb 
bing  pain  in  the  head  ;  roaring  in  the  ears ;  vertigo, 
with  nausea. 

When  children  are  the  subjects  of  attack,  Dr.  Bigel 
gives  the  following  excellent  indications  for  the  use 
of  belladonna :  "  The  children  constantly  press  their 
heads  into  their  pillows,  they  are  startled  by  the  least 
noise  or  light,  there  are,  snoring  sleep,  great  heat  of 
the  head,  face  red  and  puffed,  with  visible  beating  of 
the  arteries  of  the  head  and  neck,  swollen  veins,  and 
occasionally  hydrophobic  phenomena." 

During  the  period  of  dentition,  and  directly  after 
being  weaned,  children  are  particularly  prone  to  at- 


376      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

tacks  of  inflammation  of  the  brain.  At  this  age,  the 
child  is  exceedingly  sensitive,  and  there  is  an  unusual 
tendency  of  blood  towards  the  brain  ;  but  if  the  signs 
of  cerebral  disturbance  be  closely  watched,  we  shall 
find  no  difficulty  in  combating  them  successfully  at 
the  onset  with  belladonna.  We  have  often  employed 
this  remedy  with  satisfactory  results  when  the  follow 
ing  phenomena  were  present : 

External  indications. — Face  hot,  red,  and  swollen  ; 
eyes  red,  sparkling,  and  fixed,  or  half  open  and  dis 
torted  ;  pupils  contracted  ;  visible  throbbing  of  the 
carotid  and  temporal  arteries ;  veins  of  the  head  dis 
tended  ;  constant  boring  with  the  head  into  the  pil 
lows  ;  paralysis  of  one  or  more  parts ;  convulsive 
movements  ;  rapid,  small,  or  intermittent  pulse  ;  sub- 
sultus  tendinum  ;  distortion  of  the  features  ;  grinding 
of  the  teeth  ;  tongue  bright  red,  and  cracked ;  urine 
scanty  or  suppressed. 

Physical  sensations. — Sharp,  throbbing,  or  confused 
pain  in  the  head  ;  great  restlessness  and  agitation ; 
intolerance  to  sound  and  light ;  thirst ;  head  and  face 
very  hot ;  limbs  cold,  with  internal  burning  heat ; 
roaring  or  humming  in  the  ears  ;  deafness  ;  inability 
to  speak  or  to  swallow  ;  nausea  and  vomiting  during 
the  course  of  the  disease ;  sparks,  flashes,  or  visions 
before  the  eyes. 

Mental  and  moral  symptoms. — Great  sensitiveness 
of  the  nervous  system  ;  violent  delirium  at  night ; 
profound  sleep  ;  mania ;  hydrophobic  symptoms. 

Belladonna  is  likewise  especially  necessary  in  in 
flammations  of  the  brain,  proceeding  from  metastases 
of  scarlatina,  measles,  erysipelas,  and  smallpox. 

Its  specific  action  is  upon  the  cortical  substance, 
the  tubercula  quadrigemina,  and  the  membranes  of 
the  brain.  When  febrile  symptoms  are  strongly  pro 
nounced,  it  should  be  preceded  by  aconite,  or  given  in 
alternation  with  it. 

Administration. — We  advise  from  the  first  to  the 
third  attenuation  for  adults,  and  from  the  third  to  the 
sixth  for  children.  As  a  general  rule,  the  dose  may 
be  repeated  every  two  hours  until  the  required  im 
pression  is  produced  upon  the  inflamed  structure. 

There  is  no  proof  that  aconite  affects  specifically 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      377 

either  the  brain  or  its  envelopes.  In  autopsical  ex 
aminations  of  those  who  have  died  from  having  acci 
dentally  taken  poisonous  doses,  no  traces  of  inflam 
mation  have  been  found  in  the  cortical  substance,  or 
the  membranes  of  the  brain,  and  but  slight  marks  of 
action  in  the  medullary  structure.  The  prominent 
symptoms  to  which  large  doses  give  rise,  are,  "  numb 
ness  and  tingling  of  the  parts  about  the  mouth  and 
throat,  and  of  the  extremities,  vomiting,  contracted 
pupil,  and  failure  of  the  circulation." — Pereira,  Ma- 
teria  Medica,  vol.  ii.,  p.  153.  The  intellectual  powers 
remain  unaffected,  and  neither  convulsions  nor  stupor 
usually  occur. 

Dr.  Lombard,  of  Geneva,  in  his  clinical  practice, 
and  in  his  experiments  on  animals,  found  that  the  in 
ternal  exhibition  of  aconite,  generally  had  the  effect 
of  "  rendering  the  pulsations  less  frequent,  without 
irregularity,  and,  consequently,  that  it  exerted  a  de 
cidedly  sedative  effect  upon  the  heart ;  whence  he 
infers  that  it  is  a  proper  remedy  in  inflammatory  af 
fections  in  general." 

Others  have  observed,  that  its  primary  effect  was  to 
stimulate  the  action  of  the  heart  and  arteries,  and 
cause  a  universal  glow  over  the  surface  ;  while  the 
secondary  effect  wras  decidedly  sedative  upon  the  cir 
culatory  vessels. 

Its  effects  are  so  manifest  upon  the  action  of  the 
heart  and  arteries,  that  its  use  will  be  of  eminent 
service  in  all  those  cases  of  encephalitis,  or  conges 
tion,  dependent  upon  a  plethoric  state  of  the  system, 
or  organic  disease  of  the  heart.  It  should  also  be 
given  during  the  existence  of  active  febrile  symptoms, 
in  all  cerebral  affections,  and  generally  in  alternation 
with  some  positive  specific,  in  order  that  the  malady 
may  be  met  at  all  points.  Attenuation  and  repetition 
of  doses  the  same  as  belladonna. 

Opium.  It  is  conceded  by  both  schools,  that  opium, 
when  exhibited  in  moderate  doses,  exercises  upon  the 
human  constitution  two  different  effects — a  primary, 
and  a  secondary — which  are  of  directly  opposite  cha 
racters.  The  first  of  these  effects  is  invariably  stimu 
lant,  as  is  evinced  by  such  phenomena  as  increased 
force  and  frequency  of  the  pulse,  dryness  of  the  mouth 


378      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

and  throat,  a  pleasant  glow  upon  the  skin,  exaltation 
of  the  mental  faculties  and  of  the  muscular  system, 
a  sense  of  intoxication,  and  temporary  retention  of 
the  stools. 

The  secondary  manifestations  are,  general  diminu 
tion  of  sensibility  throughout  the  body,  a  feeling  of 
relaxation  and  calmness,  tremulousness  in  the  limbs, 
disinclination  to  exercise,  pulse  full  and  slow,  drowsi 
ness,  dryness  of  the  mouth  and  throat,  thirst,  nausea, 
and,  finally,  if  a  large  dose  has  been  taken,  slow  and 
laborious  respiration,  spasmodic  contractions  of  the 
muscles,  eyes  half  closed,  pupils  dilated  or  contracted, 
and  insensible  to  the  light,  bloated,  suffused,  and  be 
sotted  expression  of  countenance,  cold  and  clammy 
extremities,  respiration  gasping,  rattling,  stertorous, 
face  pale,  sunken,  and  deathlike,  rigidity  of  the  jaws, 
entire  insensibility  to  external  impressions,  pulse 
thready,  and  almost  entirely  imperceptible. 

Wood  and  Bache  suppose  "  that  the  active  principle 
of  opium  is  conveyed  into  the  circulation,  and  operates 
upon  the  brain,  and  probably  upon  the  nervous  system 
at  large,  by  immediate  contact  with  their  interior  struc 
tured—Wood  4-  Baches  U.  S.  Dis.,  p.  476. 

Opium  is  generally  supposed  to  cause  death  by  sus 
pending  the  "  cerebral  influence  necessary  to  sustain 
the  respiratory  function  ;  and  it  is  supposed,  also,  that 
the  heart  ceases  to  act  in  consequence  of  the  cessa 
tion  of  respiration." — Brodie. 

From  these  facts,  we  infer  that  the  specific  action 
of  opium  is  principally  upon  the  medulla  oblongata, 
although  the  other  symptoms  indicate  that  there  has 
been  some  action  upon  other  parts  of  the  brain,  and 
also  upon  the  skin,  and  lungs. 

In  autopsical  examinations  of  those  who  have  died 
from  the  effects  of  this  substance,  extravasated  blood 
has  been  found  in  the  brain,  distention  of  the  sinuses, 
and  of  all  the  cerebral  vessels,  but  it  is  probable  that 
many  of  these  appearances  are  results  of  the  impeded 
respiration,  the  imperfect  decarbonization  of  the  blood, 
and  the  impaired  circulation  which  have  arisen  from  a 
paralysis  of  that  portion  of  the  cerebral  mass  which 
presides  over  the  respiratory  functions,  rather  than 
from  any  specific  operation  of  the  opium  upon  these 
different  structures. 


DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM.      379 

Opium,  in  small  doses,  has  always  been  observed  to 
excite  the  venereal  propensities,  and  has  been  used 
for  this  purpose  for  a  long  period  by  the  Turks,  Chi 
nese,  and  Egyptians.  This  fact,  viewed  phrenologi- 
cally,  affords  another  proof  of  its  specific  action  upon 
the  cerebellum. 

In  proof  that  the  active  principle  of  opium  is  ab 
sorbed)  and  operates  by  actual  contact  in  producing  its 
specific  effects,  we  quote  the  following  from  Pereira 
and  Barbier :  **  The  odour  of  opium  is  frequently  re 
cognisable  in  the  secretions,  exhalations,  and  breaths 
of  persons  poisoned  by  it,  and  the  secretions,  in  some 
cases,  appear  to  possess  narcotic  properties." 

My  own  opinion,  derived  from  post-mortem  examina 
tions  of  those  who  have  been  poisoned  by  opium,  and 
from  the  effects  to  which  it  usually  gives  rise,  is,  that 
it  exercises,  first,  a  specific  action  upon  the  cerebellum 
and  medulla  oblongata.  If  the  drug  be  taken  in  mod 
erate  doses,  this  action  is  in  the  first  instance,  excitant, 
producing  venereal  desires,  erections,  accelerated  re 
spirations,  circulation,  and  augmented  muscular  force  ; 
and  secondarily,  sedative,  as  is  shown  by  the  languid, 
relaxed  and  calm  state  of  the  whole  system,  the  dimi 
nution  in  the  number  of  respirations,  and  in  the  action 
of  the  circulatory  vessels.  If  taken  in  very  large 
doses,  the  parts  appear  to  be  paralyzed  at  once,  and 
all  of  those  organs  the  functions  of  which  are  depend 
ent  upon  the  integrity  of  this  part  of  the  brain,  cease 
to  act. 

Another  specific  effect  of  opium  is  upon  the  skin, 
as  is  evinced  by  the  perspiration  and  its  odour,  and 
the  eruption  to  which  it  occasionally  gives  rise. 

Nor  is  it  at  all  improbable  that  it  may  operate 
somewhat  upon  the  par  vagum,  or  the  lungs  them 
selves. 

The  most  prominent  indications,  therefore,  for  the 
use  of  opium,  are,  exaltation  of  the  physical  and  men 
tal  powers,  succeeded  by  depression  and  calmness,  dry 
throat  and  mouth,  agreeable  reveries,  dreams,  pulse 
at  first  rapid  and  full,  afterwards  slow  and  feeble, 
drowsiness,  disinclination  to  muscular  exertion,  slow, 
irregular  and  stertorous  respiration,  profound  coma, 
pallid,  sunken  and  ghastly  face,  immoveable,  contracted, 
or  dilated  pupils,  rigidity  of  the  jaws,  cold  and  clammy 


380      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

extremities,  complete  insensibility  to  external  impres 
sions,  and  sometimes  convulsive  twitchings,  extinction 
of  the  pulse,  interrupted  and  gasping  respiration,  and 
finally  death.  It  may  be  administered  in  the  same 
manner  as  belladonna. 

Hyoscyamus,  stramonium,  and  musk,  are  applicable 
in  cases  attended  with  complete  loss  of  sense,  convul 
sive  or  spasmodic  movements ;  closed  eyes,  low  mut 
tering  delirium,  constant  movements  with  the  hands, 
dilatation  of  the  pupils,  rapid  and  anxious  respiration, 
frequent  sighing. 

If  inflammation  of  the  brain  has  arisen  in  conse 
quence  of  a  suppressed  otorrhoea,  sulphur  should  be 
employed.  In  those  cases  which  occur  in  children 
from  teething,  chamomela,  belladonna,  and  aconite,  are 
our  most  reliable  remedies. 

In  cases  of  metastases  or  extensions  of  rheumatic 
inflammations  to  the  brain,  rhus  rad.  and  rhus  tox. 
are  our  best  remedies. 

Cuprum  acetat,  should  be  given,  in  cases  which  have 
arisen  from  repelled  eruptions. 

When  encephalitis  threatens  to  run  into  dropsy  of 
the  brain,  mercurius  sol.  is  the  best  remedy  to  coun 
teract  the  tendency  to  effusion. 

If  the  disease  has  arisen  from  exposure  to  the  sun, 
repeated  doses  of  camphor  are  highly  recommended. 

Administration. — Our  attenuations  may  range  from 
the  first  to  the  sixth,  and  the  doses  repeated  every  two, 
three,  or  four  hours,  according  to  the  severity  of  the 
symptoms. 

SECTION  III. 

RAMOLL1SSEMENT    DU    CERVEAU. SOFTENING    OF    THE    BRAIN. 

It  is  not  yet  decided  whether  ramollissement,  or  soft 
ening  of  the  brain,  proceeds  from  inflammation,  or  is  a 
disease,  sui generis.  Many  of  the  French  pathologists 
suppose  it  to  be  the  result  of  inflammation ;  while 
others,  as  Rostan,  believe  it  to  be  a  disease,  sui  generis. 
Abercrombie  believes  it  may  arise  from  either  inflam 
mation,  or  from  a  condition  of  the  cerebral  structure 
analogous  to  those  parts  which  have  become  gan 
grenous  in  other  parts  of  the  body,  while  Solly  sup- 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      381 

poses  that  it  may  arise  from  inflammation,  from  a 
total  failure  of  the  circulation,  and  from  "  local  and 
general  anaemia."  Dr.  Burnett  recognises  two  kinds  of 
cerebral  and  spinal  softening,  an  inflammatory  and 
a  non-inflammatory,  and  "  which  may  always  be  dis 
tinguished  from  each  other  by  means  of  the  micro 
scope." 

Inflammation  of  the  tubular  structure  is  more  prone 
to  terminate  in  softening  than  any  other  portion  of  the 
brain,  and  it  is  usually  very  insidious  in  its  approach. 

Diagnosis. — Softening  of  the  brain  may  supervene 
suddenly  upon  an  attack  of  acute  inflammation,  like 
hydrocephalus,  or  it  may  make  its  appearance  in  a 
gradual  and  imperceptible  manner.  Some  of  the 
characteristic  symptoms  of  ramollissement  are,  in 
sensibility,  dilated  pupils,  slight  muttering  delirium, 
paralysis,  contraction  of  the  flexor  muscles,  constipa 
tion,  and  a  urinous  smell. 

Those  cases  which  have  arisen  from  an  anaemic 
condition  of  the  brain,  or  from  an  obliteration  of  the 
arteries  which  supply  this  organ,  are  usually  slow  in 
their  progress,  and  manifest  themselves  by  a  gradual 
failure  of  the  memory,  drowsiness,  an  oedematous 
state  of  the  body,  occasional  wandering  of  the  mind, 
especially  during  the  night,  general  languor,  slow, 
dragging,  and  imperfect  articulation,  constipation,  loss 
of  energy  and  ambition,  and  an  almost  entire  absence 
of  pain  or  febrile  symptoms. 

Ramollissement,  from  whatever  cause  it  may  pro 
ceed,  is  seldom  cured.  As  remedies,  however,  we  sug 
gest  opium,  hyoscyamus,  china,  secale  cornutum,  carbo 
vegetabilis,  belladonna,  nux  vomica. 

SECTION   IV. 

ACUTE    HYDROCEPHALUS. 

Diagnosis. — This  is  a  malady  almost  peculiar  to  in 
fancy  and  childhood.  The  symptoms  which  indicate 
its  approach,  are  neither  very  uniform  nor  regular. 
Indeed,  so  various  and  uncertain  are  these  symptoms, 
that  some  writers  suppose  the  effusion  to  be  dependent 
upon  a  debilitated  condition  of  the  membranes,  analo- 


382     DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

gous  to  dropsy,  while  others  attribute  it  to  inflamma 
tion  in  all  cases. 

It  may  appear  suddenly,  with  most  of  the  phenome 
na  which  we  have  designated  as  characteristic  of 
encephalitis,  viz.,  febrile  symptoms,  quick  pulse,  fits 
of  screaming,  expression  bold  and  furious,  eyes  blood 
shot  and  brilliant,  great  heat  of  the  head,  nausea,  vom 
iting,  noise  and  light  painful,  convulsions,  ending  in 
coma  and  death,  in  a  few  days.  In  cases  of  this  de 
scription,  there  exists  unquestionably  acute  inflamma 
tion  of  the  meninges  of  the  brain,  and  the  effusion 
commences  almost  simultaneously  with  the  inflamma 
tion. 

In  other  instances,  the  disease  approaches  insidi 
ously,  presenting  no  marked  symptoms  for  some  days. 
The  child  will  perhaps  be  observed  to  be  petulant,  to 
complain  of  some  pain  in  the  head,  to  become  easily 
fatigued,  to  have  occasional  flushes  of  heat,  to  be  rest 
less  at  night,  occasionally  to  grind  the  teeth,  to  have 
lost  the  appetite,  and  to  prefer  the  recumbent  position. 
After  these  symptoms  have  continued  for  an  indefinite 
period,  the  more  serious  signs  of  effusion  present 
themselves,  as  general  diminution  of  sensibility,  less 
frequent  and  more  irregular  pulse,  greater  debility, 
constant  inclination  to  keep  the  bed,  or  to  be  held  in 
the  arms,  dilatation  or  contraction  of  the  pupils,  fre 
quent  sighs,  strabismus,  or  an  unnatural  expression  of 
the  eyes,  turning  inwards  of  the  feet  and  hands,  slight 
convulsive  twitchings  of  the  face,  upper  lip,  and  arms, 
automatic  movements  of  the  hands  towards  the  head, 
rolling  of  the  head  from  side  to  side,  constant  motion 
of  the  lips,  convulsions,  paralysis,  and  coma. 

Chronic  hydrocephalus,  is  usually  the  result  of  a  very 
slight  inflammatory  action,  which  has  progressed  very 
slowly  and  insidiously.  The  indications  which  mark 
this  affection  are,  gradual  emaciation,  feebleness, 
unnatural  enlargement  of  the  head,  occasional  giddi 
ness,  and  now  and  then  strabismus. 

Therapeutics. — The  medicines  which  we  would  sug 
gest  in  this  affection  are,  belladonna,  digitalis,  nux 
vomica,  phosphorus,  stramonium,  tartar  emetic,  veratrum 
and  aconite. 

During  the  first  stage  of  the  acute  variety,  our  most 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      383 

reliable  remedies  are,  aconite  and  belladonna.  They 
should  be  given  as  often  as  once  in  two  hours,  until  a 
maniiest  effect  has  been  produced,  after  which  we  may 
repeat  as  circumstances  require. 

If  the  inflammation  has  not  been  promptly  subdued 
by  the  use  of  aconite  and  belladonna,  but  signs  of 
effusion  manifest  themselves  in  the  form  of"  deep  red, 
or  almost  brown  face  ;  eyes  rolling  in  their  orbits, 
sometimes  closed,  and  at  others  wide  open  ;  lips  dry  ; 
tongue  covered  with  a  brownish  yellow  fur ;  tension 
and  swelling  of  the  belly  ;  constipation  ;  generally,  re 
tention  of  urine,  or  difficulty  in  passing  it ;  respiration 
quick,  anxious,  and  sighing ;  deglutition  difficult ;  skin 
of  the  whole  body  dry  and  burning,  bryonia  acts  sur 
prisingly." — (Bigel.) 

Helleborus  nig.,  has  been  successfully  employed  in 
many  apparently  hopeless  cases,  which  were  attended 
with  coldness,  and  insensibility  of  the  surface ;  rapid 
and  feeble  pulse  ;  convulsions  and  spasmodic  rigidity 
of  the  limbs  ;  face  pale  and  swollen;  constant  rolling 
of  the  head  from  side  to  side  ;  moaning  ;  general  pros 
tration. 

After  decided  marks  of  effusion  obtain,  digitalis, 
mercurius  sol.,  belladonna,  veratrum  and  arnica  deserve 
our  consideration. 

Nux  vomica  and  stramonium  will  be  required  when 
great  agitation,  flushed  face,  convulsions,  strabismus, 
haggard  and  staring  look,  involuntary  twitchings  of 
the  muscles,  dilated  or  contracted  pupils,  groaning 
and  crying,  and  opisthotonos,  are  present. 

Phosphorus  and  tartar  emetic  will  be  found  useful  in 
hydrocephalus,  depending  upon  metastasis  of  some 
disease  to  the  brain,  and  in  cases  occurring  in  worn 
out  constitutions. 

Administration. — The  first,  second,  and  third  at 
tenuations  should  be  used,  and  the  doses  repeated 
once  in  from  four  to  six  hours. 

SECTION   V. 

EPILEPSY. 

Diagnosis. — The  symptoms  of  epilepsy  are  exceed 
ingly  variable.  Sometimes  premonitory  symptoms  are 
present,  like  headache,  giddiness,  ringing  in  the  ears, 


384      DISEASES    OF    TPIE    BRAIN    AND    NERVOUS    SYSTEM. 

aura  epileptica,  or  prickling  sensation  extending  from 
the  extremities  to  the  head,  drawing  inwards  of  the 
thumbs  towards  the  palms  of  the  hands,  and  sensation 
of  fulness  of  the  head ;  but  more  frequently  the  sub 
ject  is  struck  down  without  any  warning.  When  the 
attack  comes  on,  the  patient  falls  suddenly  ;  there  are 
violent  convulsive  movements,  with  loss  of  conscious 
ness  ;  the  face  and  eyes  become  distorted  ;  the  tongue 
is  often  bitten,  and  in  consequence  we  see  blood  and 
froth  issue  from  the  mouth  ;  stertorous  and  difficult 
respiration  ;  the  muscles  of  one  side  are  often  more 
agitated  than  those  of  the  other,  and  pulse  weak,  fre 
quent  and  irregular ;  after  the  paroxysms  have  sub 
sided,  the  patient  usually  sleeps  profoundly  for  eight 
or  ten  hours,  and  sometimes  remains  for  a  considerable 
period  in  a  feeble  and  languid  state,  with  headache 
and  occasional  delirium,  but  more  commonly  he  very 
speedily  recovers  his  usual  state  of  health  and  vigour. 

The  seat  of  epilepsy  is  supposed  by  some  to  be  in 
the  tubular  structure  of  the  brain,  while  others  sup 
pose  that  it  may  arise  from  irritation  of  the  spinal 
marrow,  but  nothing  is  known  with  certainty  upon  the 
subject.  The  pathology  of  epilepsy  is  still  involved  in 
obscurity. 

Causes  of  Epilepsy. — Organic  affections  of  the  brain, 
abnormal  osseous  deposites  within  the  cranium,  ill 
formed  cranium,  diseases  of  the  heart,  fractures  of  the 
skull,  violent  mental  disturbances,  secondary  syphilis, 
mercurial  affections,  derangement  of  the  stomach  and 
bowels,  onanism,  suppressed  eruptions,  habitual  dis 
charges,  and  excesses  in  the  use  of  liquors ;  prolonged 
abstinence  from  sexual  intercourse,  as  well  as  its  im 
moderate  indulgence  ;  and  the  sight  of  other  epilep 
tics. 

Prognosis. — Epilepsy  which  occurs  in  infancy  and 
childhood,  from  fright  or  suppressed  eruptions,  is  cura 
ble.  When  the  cause  is  abstinence  from  sexual  inter 
course,  a  cure  may  often  be  effected,  by  marrying : 
on  the  other  hand,  those  cases  which  proceed  from  or 
ganic  affections  within  the  cranium,  from  long  con 
tinued  masturbation,  and  from  disease  of  the  heart, 
more  especially  if  they  occur  after  the  age  of  twenty- 
five  years,  or  if  they  have  continued  for  several  years, 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      385 

are  generally  incurable.  As  a  general  rule,  idiopathic 
epilepsy  is  more  difficult  of  cure  than  the  symptomatic. 
Therapeutics. — When  called  to  a  person  labouring 
under  an  epileptic  attack,  we  should  at  once  loose  all 
of  the  clothing,  in  order  that  the  blood  may  have  free 
circulation  to  and  from  the  head,  as  well  as  in  other 
parts  of  the  body.  We  should  also  place  a  cork  or 
some  soft  substance  between  the  teeth,  to  save  the 
tongue  and  tips  from  being  wounded  by  the  convulsive 
movements  of  the  jaws.  The  patient  should  be  placed 
in  bed  and  restrained  just  sufficiently  to  prevent  him 
doing  himself  personal  injury  during  the  convulsions. 
When  the  paroxysm  is  preceded  by  an  aura,  the  at 
tack  may  sometimes  be  warded  off  by  tying  a  ligature 
firmly  just  above  the  part  where  the  aura  commences. 

It  is  a  general  impression  amongst  homoeopathic 
practitioners,  that  anti-psorics  alone  are  capable  of 
effecting  a  permanent  cure  of  epilepsy.  This  is  true 
with  regard  to  those  cases  which  are  connected  with 
syphilis,  mercurial  affections,  and  impurities  of  the 
blood,  but  when  the  disease  has  been  caused  by  injury 
to  the  cranium,  by  mental  excitements,  by  onanism,  or 
by  excesses  in  liquors  or  venery,  it  is  apparent  that  a 
different  course  of  treatment  is  requisite. 

The  most  important  remedies  in  the  treatment  of 
epilepsy  are,  belladonna,  sulphur,  mercurius,  stramo 
nium,  aconite,  china,  ignatia,  coffea, phosphorus,  arnica, 
opium,  nux  vomica,  hyoscyamus,  agaricus,  ipecacuanha, 
cicuta,  silicca,  argentum,  cocculus,  cuprum,  camphor. 

Belladonna. — Hartmann  has  found  this  remedy  spe 
cific  for  the  following  symptoms,  viz.:  "  great  irrita 
bility  of  the  whole  nervous  system,  so  that  the  patient 
is  startled  at  the  merest  trifle  ;  he  becomes  peevish 
and  sensitive,  and  is  affected  by  tremors  and  twitch  - 
ings  in  the  muscles  ;  restless  sleep,  which  is  disturbed 
by  frightful  dreams;  hyper-sensibility  of  the  eyes, 
sparks  and  flashes  before  the  eyes  ;  also  dyplopia  and 
myopia,  stammering  speech,  with  congestion  of  blood 
to  the  head,  and  nervous  distention  ;  vertigo,  with 
roaring  in  the  ears  ;  convulsions  of  particular  muscular 
parts,  subsultus,  distortion  of  the  face,"  &c.  Belladonna 
will  be  generally  applicable  in  those  cases  which  have 
been  induced  by  fright,  or  other  mental  emotions. 

17 


386      DISEASES    OF    THE   BBAIN    AND    NERVOUS    SYSTEM. 

Sulphur  and  mercurius  are  proper  when  there  is  rea 
son  to  suspect  a  psoric  or  syphilitic  taint  as  the  cause 
of  the  malady.  These  remedies  should  be  persevered 
in  until  all  trace  of  the  impure  taint  has  been  eradi 
cated. 

Stramonium,  ignatia,  hyoscyamus,  or  coffea  may  be 
administered  during  an  attack.  These  remedies  are 
appropriate  in  cases  caused  by  chagrin,  fright,  or  mor 
tification. 

Camphor  is  indicated  in  epileptic  attacks  caused  by 
taking  cold,  or  by  vexation, — particularly  if  congestion 
of  the  brain  is  threatened  ;  when  caused  by  fright, 
artemisia,  at  the  first  or  second  dilution,  has  been  found 
curative  ;  when  occurring  in  sensitive  children,  during 
the  period  of  dentition,  chamomela,  coffea,  and  hyos- 
cyamus  are  the  specifics  ;  in  the  epilepsies  of  nervous 
and  impressible  subjects,  with  distortion  of  the  limbs 
and  face,  bloodshot  eyes,  foaming  at  the  mouth,  livid 
face,  and  protracted  loss  of  consciousness,  cicuta  and 
stramonium  are  our  best  remedies  ;  epilepsy  induced 
by  unusual  excitements,  worms,  exposure  to  a  high 
degree  of  heat,  and  attended  with  sudden  loss  of  con 
sciousness,  and  of  muscular  power,  screams,  violent 
convulsive  movements  of  the  limbs,  gnashing  of  the 
teeth,  frothing  at  the  mouth,  livid  face  and  forehead, 
bloodshot  eyes,  and  irregular  spasmodic  twitches  in 
various  parts  of  the  body,  may  generally  be  cured  by 
hyoscyamus,  ignatia  and  corculus ;  nux  vomica  is  an 
invaluable  remedy  when  the  complaint  proceeds  from 
abuse  of  stimulants,  venereal  pleasures,  sedentary 
habits,  undue  mental  exertion,  disordered  stomach,  or 
worms  ;  in  the  epilepsies  of  drunkards,  opium  may 
often  succeed  nux  with  advantage  ;  frequently  recur 
ring  epileptic  fits  have  often  been  permanently  cured 
by  Dr.  Dunsford,  with  argentum  nit.,  belladonna,  agari- 
cus,  moschus,  and  silicea  ;  when  the  fit  arises  during 
the  course  of  an  eruptive  fever,  in  consequence  of  a 
retrocession  of  the  eruption,  caused  by  cold,  we  may 
employ  ipecacuanha,  cuprum,  and  belladonna. 

China  and  phosphorus  should  be  given  in  epilepsy 
which  has  followed  protracted  masturbation,  or  ex- 
ce'sses  in  venery.  The  latter  may  also  be  used  in 


DISEASES    Of    THE    BRAIN    AND    NERVOUS    SYSTEM.      38T 

cases  proceeding  from  osseous  deposites  within  the 
cranium. 

Opium  and  nux  vomica. — For  the  epilepsies  of  ine 
briates  these  medicines  are  important,  and  will  often 
effect  permanent  cures,  after  the  previous  habits  of  in 
temperance  are  corrected. 

When  the  cause  consists  of  an  injury  to  the  head, 
arnica  is  our  chief  remedy — this  medicine  should  be 
used  externally  as  well  as  internally. 

If  the  paroxysms  have  been  caused  by  fright,  grief, 
chagrin,  or  from  some  sympathetic  emotion,  we  may 
often  prevent  an  attack  (homoeopathically)  by  exer 
cising  the  patient  with  some  more  potent  mental  in 
fluence,  which  shall  supersede  the  original  cause.  It 
was  upon  this  principle  that  Boerhaave  cured  a  num 
ber  of  epileptics,  at  the  hospital  for  orphans  of  Harlem, 
who  had  been  attacked  in  consequence  of  fright  from 
seeing  an  epileptic  brought  into  the  hospital  during  a 
paroxysm.  In  these  instances  Boerhaave  had  a  red- 
hot  poker  kept  ready,  in  order,  as  he  assured  these 
girls,  that  he  might  apply  it  to  their  heads,  as  soon  as 
there  was  any  indication  of  an  attack.  The  fright 
caused  by  this  idea  entirely  overwhelmed  the  other 
cause,  and  an  immediate  cure  was  generally  the  re 
sult. 

Administration. — We  commonly  advise  the  lower 
attenuations,  and  administer  the  remedy  once  or  twice 
daily,  until  a  cure  is  effected. 

SECTION   VI. 

APOPLEXY. 

Apoplexy  may  occur  as  an  idiopathic,  or  as  a  symp 
tomatic  affection,  and  in  an  inflammatory  or  an  ady- 
namic  form.  We  may  also,  with  propriety,  divide  it 
into  three  varieties,  the  sanguineous,  or  extravasation 
of  blood  upon  the  brain,  the  serous,  or  effusion  of  se 
rum,  and  finally  the  simple  apoplexy,  produced  by  ab 
normal  distention  of  the  vessels  of  the  brain.  The 
symptoms  will  vary  according  to  the  extent  of  the  ef 
fusion,  and  the  part  of  the  brain  in  which  the  extrava 
sation  is  located.  If  the  fluid  is  so  situated  as  to  make 
pressure  upon  the  hemispheres,  there  will  be  a  sudden 


388      DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM* 

loss  of  consciousness,  coma,  and  stertorous  respiration. 
If  the  effusion  occurs  upon  the  surface  of  the  vertex  of 
the  brain,  the  symptoms,  according  to  Abercrombie, 
will  be  moderate  in  the  first  instance,  but  as  the  effu 
sion  increases,  comatose  symptoms  come  on,  and  the 
patient  succumbs  ;  when  the"effusion  occurs  near  the 
base  of  the  brain,  there  is  no  coma  or  loss  of  conscious 
ness,  but  we  find  loss  of  speech  and  paralysis.  It  is 
most  common  at  the  age  of  fifty  or  sixty  years,  but  it 
sometimes  occurs  in  subjects  of  twenty  five  or  thirty 
years. 

Although  this  formidable  malady  is,  in  general, 
sudden  and  overwhelming  in  its  attack,  yet,  fortu 
nately,  in  the  great  majority  of  cases,  especially  of  the 
inflammatory  form,  there  are  well  pronounced  pre 
monitory  symptoms  for  days,  and  sometimes  for  weeks 
preceding  its  onset,  such  as  vertigo,  drowsiness, 
throbbing  pain,  or  sensation  of  numbness  in  the 
head,  frequent  flushing  of  the  cheeks,  unusual  heat 
in  the  head,  and  disinclination  to  bodily  or  men 
tal  exertion.  These  symptoms,  therefore,  should  al 
ways  receive  prompt  attention,  when  occurring  in 
those  who  are  predisposed  to  apoplexy,  in  order  that 
the  threatened  danger  may  be  averted  in  due  time. 

Causes. — Apoplexy  occurs  most  frequently  in  large 
towns,  amongst  the  opulent  and  luxurious.  The  im 
pure  air  of  cities,  acts  as  a  powerful  predisposing 
cause,  and,  in  connection  with  the  numerous  vices 
prevalent  in  a  patrician  society,  as  want  of  exercise, 
high  living,  excesses  in  the  use  of  stimulants,  and  the 
pleasures  of  love,  affords  a  solution  of  the  fact  of  its 
more  frequent  occurrence  in  towns  than  in  the  coun 
try. 

The  most  common  proximate  causes  of  sanguineous, 
and  of  simple  apoplexy,  are,  want  of  exercise,  excesses 
in  eating,  drinking,  love,  suppression  of  an  habitual 
nasal  haemorrhage,  unnatural  fulness  of  the  blood-ves 
sels  of  the  brain  from  any  cause,  violent  mental  emo 
tions,  excessive  study,  and  great  physical  exertion. 

The  most  favourable  condition  for  the  occurrence  of 
serous  apoplexy,  is,  general  debility  and  innervation, 
whether  from  insufficient  nutriment,  excessive  mental 
or  bodily  labour,  sickness,  old  age,  long  continued 


DISEASES    OP   THE    BRAIN    AND    NERVOUS    SYSTEM.      380 

intemperance,  abuse  of  drugs,  or  the  depressing  emo 
tions. 

Frank  asserts  that  it  is  not  rare  to  find  serous  and 
sanguinous  effusion  in  the  same  brain,  and  he  has  de 
tailed  several  instances  of  this  kind  which  have  fallen 
under  his  own  observation. 

Diagnosis. — Inflammatory  apoplexy  is  for  the  most 
part  confined  to  individuals  of  a  sanguine  tempera 
ment,  plethoric,  with  short  thick  necks,  vigorous  cir 
culation,  and  a  great  amount  of  animal  heat.  The 
attack  is  often  preceded  by  vertigo,  unusual  heat 
about  the  head,  face  red  and  full,  eyes  injected  and 
troubled  with  muscae  volitantes.  The  invasion  of  the 
malady  is  so  sudden,  that  the  patient  is  struck  down 
instantly,  deprived  of  all  consciousness  and  power  of 
voluntary  motion.  The  respiration  becomes  stertorous, 
the  cheeks  and  lips  puffed  out  at  each  expiration,  the 
pulse  slow  and  full,  pupils  dilated,  face  red  or  livid, 
or  purplish,  throbbing  of  the  carotid  and  temporal  ar 
teries,  eyelids  convulsed,  either  closed  or  half  open, 
paralysis  of  the  muscles  of  one  side,  or  of  the  face  on 
ly,  and  distention  of  the  veins  of  the  head  and  neck.  Af 
ter  a  time  the  breathing  becomes  less  stertorous,  the  pulse 
more  soft,  and  some  signs  of  returning  consciousness 
indicate  convalescence ;  or,  as  more  often  happens,  these 
symptoms  become  more  grave,  and  the  vital  forces 
continue  to  fail,  until  the  patient  sinks  under  the  dis 
ease. 

Some  of  the  marks  which  characterize  serous  apo 
plexy,  are,  general  appearance  of  debility,  face  pale 
and  haggard,  pulse  below  the  natural  standard  in  fre 
quency  and  fulness,  surface  cool  and  clammy,  pupils 
contracted  or  dilated,  loss  of  consciousness,  and  paral 
ysis  of  one  or  more  parts. 

If  the  patient  recovers  from  the  more  serious  symp 
toms  of  this  malady,  there  usually  remains  for  a  long 
time,  a  paralytic  condition  of  one  or  more  parts  of  the 
body. 

Therapeutics. — We  commend  the  following  medi 
cines  in  apoplexy  :  belladonna,  opium,  rhus  toxicoden- 
dron,  cojfea,  phosphorus,  laurocerasus,  acid  hydrocyanic, 
and  protoxide  of  nitrogen. 

Belladonna. — External  indications. — Profound  coma ; 


390     DISEASES    OF   THE    BRAIN    AND    NERVOUS    SYSTEM. 

stertorous  respiration  ;  face  swollen,  bluish  or  dark- 
red  ;  spasmodic  movements  of  the  lips  ;  distention  of 
the  veins  of  the  head  and  neck  ;  visible  throbbing  of 
the  carotid  and  temporal  arteries  ;  dilatation  of  the 
pupils  ;  injection  of  the  conjunctiva ;  grinding  of  the 
teeth  ;  suppression  or  involuntary  discharge  of  urine  ; 
paralysis  and  immobility  of  one  limb,  or  of  one  side  of 
the  body. 

Physical  sensations.  —  If  the  patient  is  sufficiently 
conscious  to  note  his  sensations,  belladonna  will  cover 
confusion  of  the  senses  ;  vertigo  ;  throbbing  pains  in 
the  head  ;  loss  of  memory  ;  heaviness  and  pressure  in 
the  head ;  cramp-like  pains  in  the  face  and  limbs ; 
dimness  of  sight ;  double  vision  ;  deep-seated  pain  in 
the  orbits ;  roaring  in  the  ears  ;  hardness  of  hearing  ; 
loss  of  taste,  or  putrid  taste  ;  constipation  ;  lameness 
and  weakness  of  the  extremities  ;  painful  sensitive 
ness  of  the  whole  surface  to  the  touch ;  drowsiness, 
disturbed  sleep  ;  great  sensitiveness  to  cold  ;  aggra 
vation  of  the  pains  by  movement  or  by  contact. 

Mental  and  moral  symptoms. — Despondency  ;  dejec 
tion  of  spirits  ;  apathy  ;  irritability. 

Administration. — In  grave  cases,  a  drop  of  the  se 
cond  potency  may  be  given  every  half  hour,  or  every 
hour,  until  the  effect  is  manifest.  When  there  is  only 
a  predisposition  to  the  malady,  a  drop  once  in  six  or 
eight  hours  will  suffice. 

Opium. — External  indications. — Face  red,  bloated, 
and  swollen,  or  pale  and  sunken  ;  expression  of  coun 
tenance  stupid  and  besotted  ;  distortion  of  the  mouth  ; 
dropping  of  the  under  lip;  eyes  half  closed,  pupils  di 
lated,  and  insensible  to  light ;  irregular  and  snoring 
respiration ;  profound  coma,  with  stertorous  and 
rattling  respiration  ;  convulsive  and  spasmodic  mo 
tions  ;  bluish  colour  of  the  lips  and  nails  ;  general  re 
laxation  of  the  muscles ;  coldness  of  the  extremities, 
with  heat  in  the  head. 

Physical  sensations. — Stupidity,  imbecility  and  dul- 
ness  of  the  mental  faculties  and  senses  ;  drowsiness  ; 
vertigo  ;  giddiness  ;  buzzing  in  the  ears ;  heaviness, 
pressure,  and  tightness  in  the  head  ;  congestion  of 
blood  to  the  head ;  visions  ;  dryness  of  the  mouth  ; 
paralysis  of  the  muscles  of  the  throat  and  tongue  : 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.        391 

constipation,  or  involuntary  stools  ;  suppression  of 
urine  ;  numbness  and  insensibility  ;  weakness  ;  lan 
guor  ;  general  diminution  of  power  throughout  the 
organism. 

Mental  and  moral  symptoms. — High  spirits,  succeed 
ed  by  depression  ;  calmness  ;  agreeable  reflections  ; 
pleasant  fancies  ;  taciturnity  ;  courage  ;  confidence  ; 
contempt  of  danger,  and  finally  by  coma,  with  sterto 
rous  breathing. 

Administration.  —  A  drop  of  the  third  dilution  in 
water,  or  on  sugar,  and  repeated  according  to  the  ur 
gency  of  the  case. 

Rhus  toxicodendron  and  laurocerasus  are  applicable  in 
some  cases  of  adynamic  apoplexy,  after  belladonna  or 
opium.  It  is  specific  for  the  secondary  effects,  which 
have  not  been  removed  by  the  last  named  medicines  ; 
like  great  prostration  ;  paroxysms  of  fainting  ;  bruised 
pains  in  the  affected  parts ;  numbness ;  stiffness ; 
paralysis  ;  cramps ;  great  sensitiveness  to  cold  air ; 
tingling  and  twitchings  in  the  limbs ;  irresistible 
drowsiness. 

Administration. — A  drop  of  the  third  dilution  once 
in  six  or  eight  hours. 

In  the  adynamic  apoplexy  of  old  people,  phosphorus 
is  a  valuable  remedy.  The  symptoms  which  point 
to  its  use  are,  general  appearance  of  debility  and 
prostration  ;  face  pale  and  sickly  ;  eyes  sunken  ;  tor 
por  of  the  mental  and  physical  powers ;  coldness ; 
paralytic  weakness  ;  tremor  of  the  hands,  and  feeble 
pulse. 

Administration. — Same  as  rhus. 

Coffea,  ignatia,  and  nux  vomica,  may  be  exhibited 
to  remove  the  premonitory  symptoms  of  adynamic 
apoplex}^.  The  vapour  of  the  nitrous  oxyde  gas  may 
be  inhaled  with  advantage  in  cases  which  are  cha 
racterized  at  the  commencement  by  great  exhilaration, 
increase  of  muscular  force,  constant  desire  for  loco 
motion,  and  succeeded  by  profound  sleep,  or  sleep  dis 
turbed  by  visions.  This  remedy  should  be  administer 
ed  in  such  a  manner  as  to  produce  a  decided  impres 
sion. 


392       DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM. 

SECTION   VII. 
PARALYSIS. PALSY. 

Paralysis  is  characterized  by  a  partial  or  total  loss 
of  voluntary  motion  or  of  sensation.  In  some  cases 
both  sensation  and  voluntary  motion  are  destroyed. 
These  symptoms  occur  without  coma,  loss  of  con 
sciousness,  or  much  derangement  of  the  intellectual 
powers,  if  we  except  an  occasional  weakness  of  me 
mory.  It  may  follow  apoplexy,  or  arise  from  disease 
of  the  spinal  marrow.  When  it  succeeds  to  an  apo 
plectic  attack,  there  is  usually  a  paralysis  of  one  side 
of  the  body,  which  is  termed  hemiplegia.  Palsy  of 
the  lower  part  of  the  body,  or  paraplegia,  may  arise 
from  disease  of  the  brain,  or  spinal  marrow,  though 
most  commonly  the  former  organ  is  the  seat  of  the 
affection.  Partial  or  local  palsy  affects  some  particu 
lar  part  of  the  body,  as  an  arm,  wrist,  or  the 'face. 
The  muscles  of  the  face  are  most  often  affected.  This 
variety  may  arise  from  the  pressure  of  a  tumour,  from 
mechanical  injury,  or  from  disease  of  the  portia  dura. 
We  sometimes  see  a  palsied  state  of  the  wrists,  which 
has  been  termed  lead  palsy,  from  the  supposition  that 
it  owes  its  origin  to  the  absorption  of  lead  into  the 
system.  We  have  no  doubt  but  that  the  absorption  of 
lead  may  induce  this  palsy  of  the  wrists  ;  but  in  most 
of  the  cases  which  have  fallen  under  our  observation, 
we  have  been  unable  to  trace  the  cause  of  the  ma 
lady  to  this  drug.  On  the  contrary,  we  have  in 
several  instances  known  it  follow  long  exposure  to 
cold  and  wet,  in  the  act  of  driving.  In  three  instances 
this  result  has  occurred  in  individuals  in  perfect  health. 
In  one  instance,  the  exposure  took  place  after  a  course 
of  blue  pills. 

Diagnosis. — When  there  is  only  a  loss  of  voluntary 
motion,  the  part  affected  wastes  away,  and  becomes 
soft  from  want  of  use,  while  sensation  may  remain 
natural,  or,  as  sometimes  happens,  there  will  be  a 
morbid  sensibility,  or  a  bruised  and  painful  feeling  in 
the  part  affected.  I  have  known  this  morbid  sensibi 
lity  in  two  or  three  cases  to  be  exceedingly  trouble 
some,  rendering  it  impossible  for  the  patient  to  move, 


DISEASES    OF   THE    BRAIN    AND    NERVOUS    SYSTEM.        393 

or  be  moved,  without  great  pain.  In  some  cases,  there 
is  an  entire  loss  of  sensation,  as  well  as  voluntary  mo 
tion.  Often,  when  the  sensibility  of  the  part  is  only 
partially  destroyed,  formication  is  experienced  in  the 
parts  affected. 

The  loss  of  muscular  power  and  of  sensation  will  in 
all  instances  bear  a  direct  ratio  to  the  extent  and  se 
verity  of  the  original  affection  and  the  part  affected. 

Therapeutics. — Rhus  toxicodendron,  arnica,  nux  vo- 
mica,  ruta,  sulphur,  electro-magnetism.  All  of  these 
medicines,  with  the  exception  of  ruta  and  sulphur, 
are  made  use  of  as  chief  remedies  by  allopathic,  as 
well  as  homoeopathic  practitioners. 

Rhus  may  be  used  in  cases  of  paralysis,  when  there 
is  great  sensitiveness  to  cold  air  ;  general  debility ; 
tingling  or  itching  in  the  paralyzed  parts  ;  languor ; 
constant  desire  to  lie  in  bed ;  fainting  fits. 

Arnica  may  be  given  to  paralytics  with  feeble  or 
impaired  constitutions,  whose  pains  are  aggravated  by 
motion  or  talking  ;  with  painful  sensitiveness  of  the 
whole  body  ;  tremors  of  the  limbs  ;  relaxation  and 
general  debility  ;  hemiplegia. 

Nux  vomica  is  suitable  for  paralysis  occurring  in 
sanguine  or  choleric  individuals.  The  indications 
for  its  use  are,  paralysis,  especially  of  the  lower  ex 
tremities  ;  trembling  of  the  limbs ;  painful  contrac 
tive  sensations  ;  cramps  and  spasmodic  twitchings  in 
the  parts ;  languor  ;  heaviness  and  stiffness  of  the 
limbs ;  great  sensitiveness  to  cold  air  ;  paralysis 
which  has  been  induced  from  abuse  of  stimulants, 
coffee,  or  narcotics ;  or  where  the  predisposing  cause 
has  been  want  of  exercise,  with  severe  and  protracted 
mental  labour. 

Ruta  has  been  highly  extolled  as  a  remedy  for 
rheumatic  paralysis  of  the  tarsal  and  carpal  joints.  It 
is  also  indicated  in  local  paralysis,  which  has  followed 
surgical  operations,  or  which  is  owing  to  injury  or 
pressure  upon  some  particular  nerve. 

We  have  found  sulphur  of  eminent  service  in  cases 
of  paralysis,   accompanied  by  great   irritability  and 
sensitiveness  of  the  rectum,  and  causing  excruciating 
pains  during  every  attempt  at  an  alvine  evacuation. 
In  all  of  those  oases  of  palsy  which  have  resisted 
17* 


394        DISEASES    OF    THE    BRAIN    AND    NERVOUS  SYSTEM. 

our  treatment  by  internal  remedies,  we  should  have 
recourse  to  electro-magnetism.  This  agent,  when  pro 
perly  and  perseveringly  applied,  will  often  effect 
cures  after  all  other  means  have  failed.  This  potent 
remedy  should  always  be  applied,  however,  under  the 
direction  of  a  judicious  physician ;  for  it  is  an  agent 
capable  of  doing  serious  injury  when  improperly  em 
ployed. 

We  also  suggest  baryta  carb.,  cocculus,  lachesis, 
plumbum,  pulsatilla,  bryonia,  conium  maculatum. 

Administration. — The  remedies  may  be  exhibited  at 
from  the  first  to  the  third  attenuations, — a  dose  once  or 
twice  daily. 

SECTION  VIII. 

DELIRIUM    TREMENS. MANIA    A    POTU. 

Dr.  Solly,  in  his  treatise  on  the  human  brain,  classi 
fies  delirium  as  an  anaemic  affection  of  the  brain. 
Amongst  other  reasons  for  this  conclusion,  he  asserts 
that  in  all  cases  which  he  has  examined  after  death, 
he  •'  has  invariably  found  the  hemispherical  ganglion 
pale  and  bloodless  ;  the  venous  canals  were  generally 
full ;  and  occasionally  the  arachnoid  thickened,  as  if 
it  had  been  the  subject  of  chronic  inflammation."  A 
judicious  distinction  is  made  by  this  author,  and  some 
others  of  recent  date,  between  the  delirium  which  is 
produced  by  the  sudden  withdrawal  of  stimulants 
after  a  long  and  free  indulgence,  and  that  which  may 
be  excited  in  any  person  by  an  excessive  temporary 
use  of  stimulants.  The  former  he  terms  true  delirium 
tremens,  which  depends  upon  an  anaemic  condition  of 
the  hemispherical  ganglion ;  and  the  latter,  delirium 
ebriosorum,  depending  upon  a  congested  state  of  the 
same  structure. 

Dr.  Solly  enumerates  the  following  as  a  few  of  the 
marks  of  distinction  between  the  two  maladies.  "The 
head  and  skin  generally  are  cool  and  moist  in  delirium 
tremens.  dry  and  hot  in  delirium  ebriosorum.  The  pu 
pil  varies  in  both  according  to  the  stage  ;  in  the  early 
stage  of  both  it  is  generally  contracted,  in  the  latter 
stage  dilated.  The  conjunctiva  red  and  injected  in 
delirium  ebriosorum  ;  the  reverse  in  delirium  tremens. 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.        395 

The  mental  derangement  in  the  former  is  more  allied 
to  an  exalted,  excited  state  of  intellect ;  in  the  latter 
it  approaches  fatuity  and  depression.  The  tongue  is 
generally  pale  and  furred  in  delirium  tremens,  some 
times  unnaturally  clean  and  red  ;  in  delirium  ebrioso- 
rum  it  is  usually  dry,  and  sometimes  brown,  but  this  is 
no  certain  guide.  The  pulse  is  most  uncertain ;  but, 
upon  the  whole,  there  is  less  power  in  the  beat  of  the 
artery,  and  that  more  varied,  in  delirium  tremens  than 
in  delirium  ebriosorum." 

Diagnosis. — True  delirium  tremens  is  characterized 
by  a  wild  expression  of  countenance  ;  eyes  fixed  in 
tently  and  earnestly  upon  some  imaginary  object  in 
the  room  ;  constant  endeavours  to  grasp  or  to  avoid 
these  visionary  images ;  motions  sudden  and  rapid ; 
tremour  of  the  hands  and  limbs,  also  of  the  tongue 
when  protruded ;  tongue  flabby  and  moist ;  pulse 
nearly  natural ;  skin  cool  and  often  covered  with 
perspiration  ;  constant  desire  to  move  about ;  inability 
to  concentrate  the  thoughts  for  any  length  of  time  ; 
entire  inability  to  sleep  ;  mind  wandering  and  deli 
rious  ;  bowels  regular ;  face  bloated ;  absence  of 
thirst,  heat,  and  other  febrile  symptoms ;  general  ap 
pearance  of  debility. 

Delirium  ebriosorum  may  be  recognised  by  the  un 
natural  heat  and  dry  ness  of  the  skin  ;  face  flushed  ; 
conjunctiva  red  and  injected  ;  expression  fierce  and 
excited  ;  pulse  frequent  and  full ;  tongue  dry  and  red, 
or  brown ;  boisterous  delirium  ;  increase  of  muscular 
strength  ;  strong  pulsations  in  the  carotid  and  tempo 
ral  arteries  ;  pupils  first  contracted,  afterwards  dilated ; 
inability  to  sleep  night  or  day. 

Causes. — Excessive  and  protracted  use  of  poor 
liquors,  abuse  of  opium,  and  other  narcotics.  The 
proximate  cause  of  the  malady  is  the  sudden  with 
drawal  of  the  accustomed  stimulant.  Delirium  ebri 
osorum  arises  from  an  excessive  temporary  use  of 
liquors.  Alcohol,  being  decidedly  specific  in  its  action 
upon  the  brain,  is  manifestly  capable,  when  abused, 
of  producing  an  inflammation  of  this  organ,  and,  con 
sequently,  the  symptoms  which  characterize  delirium 
ebriosorum.  A  long-  continued  abuse  of  this  stimu 
lant  induces  an  anaemic  condition  of  the  brain  and 


396      DISEASES    OP    THE    BRAIN    AND    NERVOCS    SYSTEM. 

nervous  system,  thus  developing  the  legitimate  secon 
dary  effect  of  the  article,  while  its  temporary  abuse 
induces  the  legitimate  primary  effects  which  wre  ob 
serve  in  delirium  ebriosorum. 

Therapeutics. — Opium,  nux  vom.,  belladonna,  hyoscy- 
amus,  stramonium,  ether  vapour,  chloroform,  protoxide 
of  nitrogen. 

Opium. — External  indications. — Skin  cold  and  cov 
ered  with  sweat- ;  tongue  moist  and  red  ;  wild  and 
staring  expression ;  motions  rapid  and  constant ;  grasp 
ing  at  imaginary  visions  ;  pulse  rather  below  the 
natural  standard  ;  tremour  of  the  hands  and  limbs  ; 
unsteadiness  in  moving  about ;  face  pale  and  bloated. 

Physical  sensations. — Tormented  with  frightful  or 
fantastic  visions  ;  giddiness  ;  confusion  of  ideas ;  ina 
bility  to  compose  or  to  concentrate  the  mind,  or  to 
sleep  ;  sensation  of  numbness  or  prickling  in  different 
parts  of  the  body. 

Mental  and  moral  symptoms. — Delirium  ;  frightful 
or  fantastic  visions  ;  confusion  of  ideas  ;  stupefaction  : 
gloomy  feeling  ;  inclination  to  commit  suicide. 

Nux  vom, — External  indications. — Trembling  of  the 
limbs :  spasmodic  twitchings  in  different  parts  of  the 
body  ;  countenance  pale  and  bloated  ;  tongue  white 
and  moist ;  vomiting  ;  surface  covered  with  sweat. 

Physical  sensations. — Constant  uneasiness,  anguish, 
and  desire  to  run  away  ;  troublesome  visions  ;  pres 
sure  and  burning  at  the  stomach  ;  constipation  ;  ver 
tigo  ;  headache  ;  cold  extremities  ;  head  cold  or  hot ; 
sensation  of  debility  or  faintness. 

Mental  and  moral  symptoms. — Silent ;  apprehensive 
of  death  ;  confusion  of  ideas  ;  depression  of  spirits ; 
desire  to  be  in  the  open  air. 

Belladonna  is  well  adapted  for  the  cure  of  delirium 
ebriosorum,  occurring  in  individuals  of  a  full,  plethor 
ic  habit,  and  presenting  the  following  symptoms :  con 
gestion  of  blood  to  the  head  ;  heat  and  pain  in  the 
head ;  flushed  face ;  injected  eyes  ;  boisterous  deli 
rium  ;  insomnia  ;  strong  pulsations  of  the  carotid  and 
temporal  arteries ;  great  nervous  erethism  ;  tongue 
and  mouth  red,  hot,  and  dry  ;  thirst  ;  trembling  of  the 
}imbs ;  cramplike  pains;  starting  suddenly  from 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      397 

sleep ;  failure  of  memory  ;  pain  in  the  neck  and  limbs  ; 
sparks  before  the  eyes  ;  visions. 

Stramonium  and  hyoscyamus  may  be  exhibited  in 
cases  complicated  with  epileptic  paroxysms,  when 
there  are,  convulsive  movements  ;  subsultus  tendi- 
num  ;  fainting  fits ;  muttering  delirium  ;  picking  at 
imaginary  objects ;  suppression  of  the  secretions ; 
extreme  irritability ;  constant  and  rapid  motions ; 
contraction  and  stretching  of  the  limbs  ;  irascible  ; 
noisy,  and  difficult  to  manage. 

Administration, — In  urgent  cases,  the  remedies  may 
be  given  at  the  second  or  third  attenuations  every 
hour  until  the  symptoms  begin  to  yield. 

The  vapour  of  sulph.  ether,  of  chloroform,  and  the 
nitrous  oxyde  gas,  may  be  inhaled  with  advantage  in 
cases  which  are  characterized  in  the  commencement 
by  great  mental  exhilaration ;  increased  muscular 
force  ;  constant  desire  to  move  about  rapidly,  to  dance, 
to  sing,  to  leap,  to  fight,  or  do  something  extravagant ; 
flushed  cheeks  ;  accelerated  respiration  :  frequent 
pulse,  succeeded  in  a  short  time  by  profound  sleep,  or 
sleep  disturbed  by  visions ;  general  insensibility  to 
external  impressions,  with  pallid  and  deathlike  expres 
sion  of  countenance. 

These  remedies  are  admirable  specifics  in  this  af 
fection,  and  we  have  known  their  exhibition  in  seve 
ral  instances  of  serious  mania  a  potu,  effect  the  most 
speedy  and  happy  cures.  They  should  never  be  ad 
ministered  except  through  the  advice,  and  under  the 
personal  superintendence  of  a  medical  man. 

SECTION  IX. 

INSANITY. 

If  it  be  true,  that  the  cortical  substance  of  the  brain 
is  the  exclusive  seat  of  the  intellectual  faculties,  it 
follows,  that  diseases  of  this  structure  must  be  suc 
ceeded  by  more  or  less  mental  disturbance. 

Insanity  is  supposed  to  be  hereditary,  and,  so  far  as 
a  general  similarity  between  parent  and  child,  rela 
ting  to  physical  conformation  and  temperament,  is 
concerned,  there  may  be  an  hereditary  influence  ;  but 
the  inheritance  bv  children  of  the  mental  and  moral 


398      DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM. 

imperfections  of  parents,  appears  to  us  to  admit  of 
much  doubt.  When  the  infant  enters  the  world,  his 
physical  organization  is  complete,  and  all  of  the  or 
gans  exercise  their  functions  in  a  healthy  and  uniform 
manner,  while  for  a  long  period  there  are  but  few,  if 
any,  of  those  manifestations  denominated  intellectual. 
On  the  contrary,  the  intellect,  as  it  gradually  mani 
fests  itself  in  the  child,  even  until  its  full  development 
in  the  adult,  constantly  exhibits  the  influence  and  the 
impressions  which  have  been  produced  by  circum 
stances,  as  early  associations,  parental  example,  edu 
cation,  habits  of  action  and  thought,  poverty,  riches, 
hardships,  indulgence,  &c.  The  proximate  cause  of 
insanity  is  not  a  derangement  of  the  mind,  but  an  ac 
tual  disease  of  the  cortical  substance  of  the  brain,  and, 
in  order  to  avoid  the  consequences  of  this  diseased 
condition,  it  is  only  necessary  to  avoid  all  of  those 
causes  capable  of  producing  inflammation  or  irrita 
tion  of  this  structure.  So,  in  effecting  a  cure,  it  is 
necessary  to  act  with  our  medicines  upon  the  organ 
diseased,  rather  than  upon  the  mental  aberration. 

My  respected  preceptor,  Dr.  Brigham,  in  his  sixth 
Annual  Report  to  the  Managers  of  the  New  York 
State  Lunatic  Asylum,  inculcates  the  importance  of 
early  physical  and  moral  education,  in  order  that  in 
sanity  may  be  averted  in  those  who  are  physically 
predisposed  to  it.  Doctor  Brigham  observes:  "Great 
pains  should  be  taken  to  form  a  character  not  subject 
to  strong  emotions,  to  passions,  and  caprice.  The  ut 
most  attention  should  be  given  to  securing  a  good 
bodily  constitution.  Such  children  should  be  confined 
but  little  at  school ;  they  should  be  encouraged  to  run 
about  the  fields,  and  take  much  exercise  in  the  open 
air,  and  thus  secure  the  equal  and  proper  development 
of  all  the  organs  of  the  body.  They  should  not  have 
the  intellect  unduly  tasked.  Very  early  cultivation  of 
the  mind,  and  the  excitement  of  the  feelings  by  the 
strife  for  the  praise  and  the  honour  awarded  to  great 
efforts  of  mind  and  memory,  are  injurious  to  all  chil 
dren,  and  to  those  who  inherit  a  tendency  to  nervous 
diseases,  or  insanity,  most  pernicious.  In  after  life, 
persons  thus  predisposed  to  insanity,  should  be  careful 
to  avoid  engaging  in  any  exciting  or  perplexing  busi- 


DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM.     399 

ness  or  study,  and  should  strive,  under  all  circum 
stances,  to  preserve  great  equanimity  of  temper.'' 

The  impression  has  always  obtained,  until  within 
the  last  century,  that  insane  persons  were  possessed 
of  evil  spirits,  and  that  all  remedial  measures  must 
be  directed  towards  expelling  from  the  body  the  tor 
menting  demon.  It  is  only  of  very  recent  date  that 
correct  doctrines  have  been  inculcated  in  regard  to 
the  true  nature  and  seat  of  this  grievous  malady;  but 
the  researches  of  Pinel,  Esquirol,  and  Connolly  have 
conduced  much  to  enlighten  the  profession  upon  this 
previously  mysterious  subject,  and  to  point  out  suc 
cessful  modes  of  treatment. 

The  different  varieties  of  mental  alienation  have 
been  classified  as  follows  : 

1 . — MANIA, 

Consisting  of  an  entire  perversion  and  derangement 
of  the  intellectual  and  moral  qualities.  The  patient 
seizes  at  the  same  time  upon  topics  the  most  dissimi 
lar,  passing  from  one  to  the  other  without  order  or  ar 
rangement,  and  reasons,  draws  inferences  and  forms 
opinions,  without  any  regard  to  logic  or  common  sense. 
The  intellect  is  deranged  on  all  subjects,  and  the  moral 
qualities  indicate  their  perversion,  by  ferocity,  unna 
tural  hatreds,  rage,  quarrelsomeness,  continual  desire 
to  do  mischief,  and  an  urgent  propensity  to  carry  into 
immediate  effect  any  fancy  which  may  strike  the  imagi 
nation.  At  the  same  time  the  patient  is  perfectly  con 
scious  of  his  identity, — has  a  kind  of  an  idea  of  right 
and  wrong,  and  is  fully  aware  of  what  he  is  doing : 
but  the  mind  operates  through  a  diseased  organ,  the 
healthy  equilibrium  is  lost,  vague  and  absurd  fancies 
take  the  place  of  reason,  and  the  individual  is  impel 
led  to  obey  the  dictates  of  his  diseased  imaginings. 
Mania  is  usually  unaccompanied  by  fever,  except,  per 
haps,  at  its  very  commencement,  although  there  is  a 
great  exaltation  of  the  mental  and  muscular  powers. 
It  has  also  been  observed  that  maniacs  are  capable  of 
enduring  the  most  severe  bodily  inflictions,  and  the 
most  intense  cold,  without  evincing  much  conscious 
ness  of  pain, — also  extreme  and  protracted  hunger  and 
thirst,  without  serious  inconvenience. 


400      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

Dr.  Brigham  remarks,  that  "  insanity  often  com 
mences  in  a  very  insidious  manner.  Some  appear  to 
be  deranged  only  as  regards  their  feelings  or  moral 
qualities.  They  are  noticed  to  be  different  from  what 
they  formerly  were  ;  to  be  more  restless  and  sleepless, 
or  unnaturally  morose  and  irritable.  Some  manifest 
an  unfounded  dread  of  evil,  say  but  little,  shun  society, 
and  are  suspicious  of  their  dearest  friends  and  rela 
tives,  while  others  are  unusually  vivacious  and  plea 
sant,  or  quarrelsome  and  abusive.  Such  changes  of 
character  and  habits,  will  usually  be  found  to  be  sub 
sequent  to  some  reverse  of  fortune,  loss  of  friends,  or 
sickness,  and  should  excite  alarm.  Persons  thus  af 
fected,  will  converse  rationally,  and  in  company,  or 
before  strangers,  will  conceal  their  peculiarities,  and 
thus  are  known  to  be  insane  but  to  very  few,  until 
some  violent  act  leads  to  an  investigation,  and  then 
it  is  found  they  have  long  been  partially  deranged. 
This  is  the  case  with  most  of  those  who  commit  sui 
cide.  Often  insanity  exists,  in  a  slight  degree,  for 
months,  and  is  only  noticed  by  the  most  intimate 
friends  or  relatives,  and  then  suddenly  assume  an 
alarming  form,  leading,  in  some  instances,  to  homicide, 
and  in  others,  to  self-destruction."* 

Frank  asserts,  4i  that  mania  may  alternate  with  hy 
pochondria,  melancholia,  or  dementia.  That  it  may 
be  continued,  remittent,  or  intermittent.  Intermittent 
mania  returns  every  eight  days,  every  month,  every 
three  months,  every  year,  every  two  years,  &c."  Ac 
cording  to  the  same  author,  "  mania  may  terminate 
by  various  crises  :  mucous  or  bloody  stools,  vomitings, 
ptyalism,  leucorrhoea,  epistaxis,  re-establishment  of 
the  menses  or  of  suppressed  hemorrhoids,  varices, 
eruptions,  erysipelas,  and  boils.  It  may  terminate  by 
continued  or  intermittent  fevers.  It  may  degenerate 
into  melancholia,  or  dementia.  The  diseases  with 
which  maniacs  finally  succumb,  are  cerebral  fever, 
apoplexy,  inflammation  of  the  rneninges,  phthisis  pul- 
monalis,  and  ulceration  of  the  intestines  ;"  complete 
exhaustion,  also,  of  the  physical  and  mental  forces,  is 
a  common  termination  of  insanity. 

*Dr.  B.'s  Eighth  Annual  Report. 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      401 
2.  — MONOMANIA, 

Is  characterized  by  derangement  upon  some  particu 
lar  subject  which  constantly  occupies  the  thoughts  fo 
the  almost  entire  exclusion  of  everything  else.  When 
the  patient's  attention  is  diverted  from  the  subject  of 
his  insanity,  he  reasons  correctly  and  converses  ration 
ally  upon  all  other  topics  presented  to  him ;  and  even 
upon  the  subject  of  his  derangement,  he  reasons  con 
sistently  upon  his  false  data.  Monomania  may  be  of  a 
gay  or  of  a  sad  character,  but  in  a  majority  of  instan 
ces,  the  monomaniac  dwells  upon  a  painful  train  of 
ideas.  Sometimes  a  prey  to  the  most  absurd  fears 
and  dreads,  as  of  poverty,  being  violently  killed,  suicide, 
homicide,  of  having  committed  the  unpardonable  sin,  or 
of  some  serious  impending  calamity  ;  sometimes  he 
imagines  himself  a  clock  and  stands  in  a  corner  of  the 
room  through  the  day,  swinging  his  arms  like  a  pen 
dulum  ;  or  an  animal,  and  imitates,  as  far  as  he  is  able, 
its  peculiarities  ;  or  that  he  has  no  legs  or  arms,  and 
therefore  refuses  to  walk  or  help  himself;  or  that  he  is 
full,  and  therefore  cannot  eat  or  drink  any  more ;  or. 
like  J.  J.  Rousseau,  that  all  men  are  his  enemies,  and 
are  seeking  to  ruin  him.  At  other  times  he  imagines 
himself  to  be  the  Saviour,  or  a  great  prophet,  or  the 
emperor  of  the  world,  or  some  renowned  statesman, 
philosopher,  or  general,  and  swells  about  issuing  or 
ders  suitable  to  his  fancied  dignity. 

Monomania  may  exist  in  a  light  form  for  a  long 
period,  without  attracting  particular  attention.  We 
have  at  the  present  time,  under  our  care,  two  patients 
who  have  tormented  themselves  a  good  part  of  the 
time,  for  years,  and  have  reduced  themselves  to  a 
wretched  state  of  health,  with  the  dread  of  committing 
suicide  or  homicide,  and  yet  they  have  had  the  firm 
ness  to  conceal  their  morbid  condition  from  their 
friends.  We  have  known  other  individuals  who  have 
been  thrown  into  phthisis  pulmonalis,  by  silently 
brooding  for  a  long  time  over  some  apprehended  mis 
fortune,  like  loss  of  property.  The  mind,  like  the  body, 
requires  rest  and  diversion  ;  one  set  of  muscles  cannot 
be  constantly  exercised  without  becoming  impaired  in 
their  functions,  nor  can  the  mind  dwell  upon  a  single 


402   DISEASES  OF  THE  BRAIN  AND  NERVOUS  SYSTEM. 

train  of  ideas  exclusively  and  for  a  long  time,  without 
becoming  deranged. 

•  This  malady,  like  mania,  may  be  continued,  remit 
tent,  or  intermittent.  The  cure  is  generally  preceded 
by  some  crisis,  either  physical  or  moral.  The  physical 
crises  are,  eruptions,  sweats,  vomitings,  and  diarrhoeas, 
tumours,  fevers,  acute  inflammations  of  the  brain. 
The  moral  crises  consist  of  all  those  emotions  or  pas 
sions  which,  by  violently  impressing  the  brain,  are 
capable  of  exciting  a  new  action  which  shall  supersede 
the  morbid  affection.  Under  this  head  may  be  ranked, 
sudden  and  startling  news,  fright,  rage,  violent  grief, 


3.  -  DEMENTIA. 

In  this  variety  of  insanity,  the  intellectual  faculties 
are  all  impaired  —  the  power  to  concentrate  the 
thoughts,  to  arrange  and  compare  ideas,  or  to  draw 
inferences,  is  lost.  The  past  is  a  blank  to  the  unfor 
tunate  victim,  and  thus,  tamily,  friends,  home,  the  as 
sociations  of  early  years,  as  well  as  the  cares  and 
pleasures  of  maturity,  are  all  forgotten.  Yet  the  irri 
tation  of  the  cerebral  structure  often  incessantly  im 
pels  the  patient  to  move  about,  and  to  give  utterance 
to  the  random  and  incoherent  images  which  are  con 
stantly  passing  through  his  brain.  Some  are  silent 
and  almost  insensible  to  everything  around  them.  If 
articles  are  presented  or  topics  of  interest  broached  for 
their  attention,  apparently  no  impression  is  produced, 
but  the  mind  still  pursues  its  incoherent  wanderings. 

This  form  of  insanity  is  more  difficult  of  cure  than 
either  of  the  others,  for  the  causes  are  usually  so  gradu 
al  and  insidious  that  the  cerebral  mass  becomes  hope 
lessly  disorganized,  or  the  meninges  permanently  thick 
ened  and  adherent  to  the  cranium,  before  serious 
alarm  is  taken.  If,  however,  the  malady  is  attacked 
within  the  first  few  months  or  the  first  year,  hopes  of 
cure  may  be  entertained.  Dr.  Brigham  asserts  that  "  in 
sanity  is  rarely  cured  after  it  has  uninterruptedly  con 
tinued  two  years,  though  there  is  always  hope  if  the 
patient  is  vigorous  and  the  form  of  insanity  varies." 

Causes.  —  In  examining  the  tables  of  the  supposed 
causes  of  insanity,  as  published  in  the  reports  issuing 


DISEASES    OF   THE    BRAIN    AND    NERVOUS    SYSTEM.      403 

from  the  different  insane  hospitals  of  Europe  and 
America,  we  find  a  very  great  variety  ;  but  we  agree 
with  Dr.  Brigham  that  the  general  causes  of  insanity 
may,  with  propriety,  be  divided  into  moral  and  physi 
cal.  Under  the  head  of  physical  causes  should  be 
included,  injuries  to  the  brain,  from  falls,  blows  upon 
the  head,  &c.  ;  all  morbid  or  medicinal  substances 
which,  when  absorbed,  exert  a  specific  action  and  are 
capable  of  powerfully  impressing  the  cerebral  organs, 
like  irritating  gases,  as  carbonic  acid,  and  nitrous  oxyde 
gas ;  vapours,  like  ether  vapour  and  chloroform  ;  also 
alcoholic  liquors,  opiates,  and  other  narcotics  ;  mercu 
ry,  electric  shocks,  sun  strokes,  excessive  labour, 
violent  exertions,  straining,  masturbation,  protracted 
sea  sickness,  exposure  to  violent  heat,  sudden  exposure 
to  cold  water,  other  diseases,  repelled  eruptions,  ex 
cesses  in  sexual  pleasures,  drying  up  of  old  ulcers,  or  of 
accustomed  issues,  turn  of  life,  suppression  of  the 
menstrual  or  lochial  discharge,  metastases  of  rheuma 
tism,  gout,  or  other  disease,  syphilis. 

The  moral  causes  comprise,  over-exertion  of  the 
intellectual  powers,  .violent  emotions,  excessive  and 
protracted  grief,  mortification,  disappointed  love  and 
ambition  ;  jealousy,  remorse,  anxiety,  exclusive  and 
protracted  thought  upon  a  single  subject,  or  a  single 
train  of  ideas,  religious  enthusiasm,  vivid  and  unre 
strained  imagination,  improper  mental  education. 

Amongst  the  physical  causes  enumerated,  it  is  well 
known  that  many  of  them  exercise  a  decidedly  specific 
action  upon  the  brain,  as  for  example,  opium,  belladon 
na,  alcoholic  liquors,  the  nitrous  oxyde,  and  carbonic 
acid  gases,  the  vapours  of  ether  and  chloroform,  &c. 
Opium  eating  is  set  down  in  works  upon  insanity  as 
one  of  the  causes  of  the  malady,  and  yet  this  remedy 
has  often  effected  cures,  both  in  the  hands  of  the  allo- 
pathist  and  the  homoBopathist.  The  vapours  of  ether 
and  chloroform  have  caused  insanity,  and  they  have 
also  effected  cures.  Alcohol  causes  one  kind  of  de 
rangement,  (delirium  tremens,)  and  yet  it  is  an  efficient 
remedy  in  effecting  cures,  in  the  hands  of  all  practition 
ers.  Taking  these  facts  into  consideration,  we  can 
easily  explain  the  modus  medendi  of  these  cures,  viz., 


404      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

the  application  of  remedies  in  accordance  with  the  only 
true  principle  of  cure,  similia  similibus  curantur. 

Want  of  sleep  is  ranked  by  Dr.  Brigham  as  the  "  most 
frequent  and  immediate  cause  of  insanity,  and  one  of 
the  most  important  to  guard  against." 

Dr.  B.  dwells  upon  this  cause  with  much  earnest 
ness,  and  endeavours  to  impress  upon  all,  the  vast  im 
portance  of  "  securing  sound  and  abundant  sleep." 
"  Long  continued  wakefulness,"  says  Dr.  B.,  "  disor 
ders  the  whole  system.  The  appetite  becomes  impaired, 
the  secretions  diminished  or  changed,  the  mind  de 
jected,  and  soon  waking  dreams  occur,  and  strange 
phantoms  appear,  which  at  firs*t  may  be  transient,  but 
ultimately  take  possession  of  the  mind,  and  madness 
or  death  ensues." — (Sixth  Annual  Report  of  the  New- 
York  Lunatic  Asylum,  by  Dr.  Brigham.) 

Pathology  of  insanity. — Induration  of  the  brain 
from  long  continued  sub-acute  inflammation,  is  a  fre 
quent  cause  of  insanity.  In  recent  and  slight  cases  of 
this  malady,  the  intellectual  faculties  exhibit  no  very 
prominent  derangement,  but  as  the  induration  pro 
gresses  and  extends,  the  hallucination  becomes  more 
strongly  pronounced',  until  eventually  complete  fatuity 
is  the  consequence.  Solly  believes  that  chronic  in 
flammation  of  the  dura  mater  is  a  very  frequent  cause 
of  insanity.  In  post-mortem  examinations  of  those 
who  have  died  demented,  Esquirol  has  observed  soft 
ening  or  increase  of  the  density  of  the  brain,  adhe- 
rences  of  the  arachnoid,  thickenings,  atrophy  and  de 
fective  organization  of  the  brain  or  cranium. 

In  monomania,  Pinel,  Frank,  and  Esquirol  assure  us 
"  that  organic  lesions  of  the  lungs  and  abdominal 
viscera,  are  more  frequent  than  alterations  of  the 
brain." 

The  latter  writer  supposes  displacements  of  the 
transverse  colon,  to  be  amongst  the  most  common  of 
these  derangements,  and  this  is  supposed  to  account 
for  the  constipation  and  the  pains  in  the  epigastric 
region,  which  are  usually  present  in  this  variety 
of  insanity. 

Many  cases  have  been  reported,  in  which  no  organic 
lesions  have  been  found  after  death,  either  in  the  brain 
or  the  abdominal  cavity,  and  on  this  account  some 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      405 

authors  recognise  a  nervous  or  vital  monomania.  It  is 
probable,  however,  in  all  cases  of  mental  derangement, 
that  either  the  brain  or  its  membranes  are  in  a  diseased 
condition,  although  our  ordinary  modes  of  examina 
tion  may  not  enable  us  in  all  cases  to  detect  it. 

Therapeutics. — Our  means  of  cure  are,  moral  and 
medicinal.  We  have  seen  that  a  majority  of  the  proxi 
mate  causes  of  mental  alienation  consists  in  undue 
exercise  of  the  emotions  and  passions.  It  is  then 
reasonable  to  suppose  that  suitable  moral  influences 
may  conduce  much  towards  removing  the  morbid  im 
pressions. 

Our  general  course  of  moral  treatment  should  con 
sist  in  calming  and  soothing  the  mind,  and  by  present 
ing  an  entirely  new  train  of  associations  and  ideas, 
gradually  divert  the  mind  from  its  morbid  channel, 
until  the  diseased  encephalon  shall  recover  its  tone, 
and  the  impressions  made  upon  it,  produce  their  legi 
timate  results.  So  important  is  it  to  abstract  the  mind 
from  all  accustomed  associations  and  thoughts,  that  it 
is  a  matter  of  extreme  difficulty  to  cure  deranged  per 
sons  so  long  as  they  are  permitted  to  remain  with  their 
friends  or  in  their  usual  residences.  For  this  reason 
alone,  an  early  removal  to  an  insane  hospital  should 
be  insisted  upon,  in  order  that  proper  restraints  may  be 
imposed,  and  the  ideas  directed  in  such  a  manner  as  to 
fill  the  mind  with  new  impressions  to  the  exclusion  of 
thaold  ones. 

In  order  to  accomplish  this  object  eifectually,  it  is 
essential  to  investigate  the  peculiarities  of  each  par 
ticular  case,  so  that  new  and  different  trains  of  thought 
may  be  perseveringly  kept  before  the  patient. 

We  take  occasion  in  this  place  to  translate  the 
admirable  remarks  of  Frank  upon  this  point :  "  The 
physician  should  endeavour  to  substitute  a  new  passion 
in  the  place  of  the  dominant  one  :  for  example,  hope 
for  despair, mildness  for  rage,  etc.  He  should  carefully 
prohibit  monomaniacs  .from  listening  to  mystical  lec 
tures  or  conversations,  and  all  religious  discussions.  In 
the  mean  time,  when  the  delirium  consists  in  the  fear 
of  the  judgments  of  God,  or  want  of  confidence  in  his 
mercy,  we  can  sometimes  cure  the  patient  by  instruct 
ing  him  in  the  true  principles  of  religion.  But  it  is 


406      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

not  necessary  to  insist,  if  the  melancholic,  instead  of 
relishing  the  solid  reasons  which  we  give  him,  finds 
in  these  conversations  a  new  aliment  to  his  delirium. 
The  consolations  of  religion  are  always  useful  to  per 
sons  whom  reverses  of  fortune,  domestic  chagrins,  un 
fortunate  love,  etc.,  have  plunged  into  a  melancholic 
state.  We  have  seen  a  case  of  melancholia  with  pro 
pensity  to  suicide,  fixed  by  excess  of  study  and  of 
onanism  ;  the  patient  suffered  moreover  much  from 
hypochondria.  Voyages,  distractions,  and  rigid  diet 
produced  only  momentary  relief.  The  consolations  of 
religion,  a  rigorous  observance  of  continence  and  of 
other  Christian  virtues,  gradually  operated  a  cure.  We 
have  re-examined  this  patient  at  the  end  of  six  years : 
he  enjoys  perfect  health,  and  when  a  sad  idea  comes 
to  darken  his  imagination,  the  most  simple  practice  of 
religion  suffices  to  restore  to  his  mind  calmness  and 
serenity.  Religion  is  capable  of  operating  similar 
cures  daily  ;  it  acts  upon  the  heart  of  man  with  much 
more  force  than  all  the  arguments  of  philosophy.  But 
its  happy  influence  is  unknown  to  the  incredulous,  and 
as  we  do  not  think  that  the  proofs  of  religion  can  be  sub 
mitted  to  the  discussion  of  a  lunatic,  we  reserve  the 
succours  contained  in  the  evo.ngelical  moral,  to  pious 
minds,  or  at  least  to  believers,  whom  different  causes 
have  plunged  into  melancholy.  As  for  unbelievers, 
we  can  only  offer  them  beautiful  maxims,  and  the  cold 
consolations  of  philosophy." — (Medecine  Practique,  par 
J.  P.  Frank.) 

Monomaniacs  may  sometimes  be  cured,  however, 
by  indulging  them  in  their  delusions,  and  encouraging 
them  in  the  hope  of  being  able  to  remove  the  cause. 
The  late  Dr.  George  McLellan  once  had  a  case  in 
point :  a  highly  intelligent  merchant  was  firmly  pos 
sessed  with  the  idea  that  there  was  a  living  eel  in  his 
stomach,  and  he  so  tormented  himself  with  the  delu 
sion,  that  he  became  seriously  ill,  and  was  obliged  to 
abandon  his  business.  He  had  employed  many  emi 
nent  physicians,  who  all  ridiculed  his  delusion,  and 
endeavoured  to  convince  him  of  its  absurdity,  but  all  to 
no  effect ;  the  idea  continued  firmly  fixed,  and  his 
*fc^eneral  health  continued  to  suffer,  when  as  a  last  re- 
or  ort,  and  in  disgust  at  the  ignorance  and  obstinacy  of 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      407 

all  physicians,  he  called  in  Dr.  McLellan,  who,  on 
investigating  his  case,  decided  ^to  indulge  the  patient 
in  his  delusion,  and  accordingly  assured  him  that  he 
had  a  monstrous  living  eel  in  his  stomach,  but  that  he 
could  give  him  a  medicine  which  would  destroy  the 
animal,  and  carry  it  off  by  way  of  the  bowels.  Ac 
cordingly  a  long  prescription  was  written,  amounting 
to  a  powerful  drastic  purgative,  and  the  patient  di 
rected  to  take  it.  At  its  operation,  the  attendant  was 
advised  to  slip  a  mutilated  eel  into  the  vessel,  and  con 
vince  the  invalid  that  it  had  passed  from  him.  The 
stratagem  succeeded  admirably,  and  the  man  was 
directly  restored  to  health,  mental  and  bodily. 

Frank  mentions  the  case  of  an  individual  "  who 
did  not  wish  to  urinate  for  fear  of  producing  a  new 
deluge  :  he  was  told  that  if  he  persisted  in  his  sad  re 
solution,  a  fire  would  occur  and  burn  up  the  universe. 
He  hastened  to  urinate,  and  his  delirium  vanished." 
Another  monomaniac  believed  himself  damned :  one 
of  his  friends,  habited  as  an  angel,  entered  his  cham 
ber  during  his  sleep,  holding  in  one  hand  a  flambeau, 
and  in  the  other  a  glistening  sword.  He  announced  to 
him,  in  behalf  of  God,  the  pardon  of  his  crimes,  and 
the  patient  was  restored  to  health.  Another  mono 
maniac  imagined  that  there  were  rabbit-burrows  in 
his  head.  To  cure  this  illusion,  they  made  a  crucial 
incision  in  his  scalp,  and  showed  him  bloody  rabbits, 
which  they  told  him  had  retired  by  the  wound." 

Much,  however,  must  depend  upon  the  peculiar  cir 
cumstances  attending  each  particular  case,  in  apply 
ing  our  moral  treatment ;  but  as  a  general  rule,  uni 
form  kindness,  respectful  treatment,  proper  discipline, 
and  a  perseverance  in  all  of  those  means  which  tend 
to  direct  the  mind  into  new  channels,  like  games, 
music,  gymnastic  exercises,  mechanical  or  agricultural 
labour,  exhibitions,  etc.,  will  enhance  very  materially 
our  success  in  the  treatment  of  this  class  of  maladies. 

The  employment  of  baths  are  highly  recommended 
by  some  authors.  As  the  daily  habit  of  general 
bathing  is  considered  at  the  present  day  not  only  es 
sential  to  health,  but  to  personal  cleanliness  and  de 
cency,  we  deem  it  as  unnecessary  to  allude  to  tb- 
habitual  attention  to  this  important  duty,  as  it  woulg 
be  to  allude  to  the  importance  and  propriety  of  othe 


408      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

personal  habits,  like  washing  the  hands  and  face, 
or  changing  the  linen.  Tepid  or  cold  baths  may  be 
employed,  as  the  condition  of  the  patient  demands  ; 
but  as  the  healthy  function  of  the  skin  is  so  often  de 
ranged  in  insanity,  and  as  nothing  conduces  so  much 
to  restore  and  preserve  this  function  as  frequent  bath 
ing,  its  importance  will  be  readily  appreciated.  Dur 
ing  the  first  stages  of  mania,  or  at  other  periods  when 
there  exists  great  excitement,  with  hot  skin  and  fre 
quent  pulse,  the  cold  shower-bath,  or  the  cold  dash, 
may  be  employed  with  decided  advantage.  Some 
discrimination,  however,  is  requisite  in  using  these 
more  powerful  applications. 

The  most  certain  specifics  which  we  possess  for  the 
cure  of  insanity,  are,  opium,  belladonna,  nux  vomica, 
aconite,  ignatia,  hyoscyamus,  stramonium,  pulsatilla, 
veratrum,  platina,  coniam,  helleborus,  aurum  mur. 

Opium  is  suitable  in  cases  of  dementia,  attended  with 
stupefaction  of  the  senses  ;  general  loss  of  mind  and 
sensation ;  indifference  to  pain  or  pleasure  ;  strange 
visions  ;  laborious  respiration;  constipation  ;  face 
pale,  or  red,  or  brownish  ;  diminished  temperature  of 
the  skin  ;  full  and  slow  pulse ;  spasmodic  motions  and 
trembling  of  the  limbs. 

Belladonna.  —  External  indications.  —  Furious  and 
violent  derangement,  or  merry  and  silly  craziness  ; 
face  red  and  hot  ;  expression  gay,  or  ferocious  with 
fixed  look  ;  eyes  brilliant,  pupils  dilated  ;  head  hot  ; 
spasms  ;  starlings  ;  sanguine  choleric  temperament  ; 
impressible  nervous  system. 

Physical  sensations. — Vertigo  ;  headache  from  con 
gestion  of  blood  to  the  head  ;  sleeplessness,  with  great 
uneasiness  and  anguish  ;  frightful  dreams,  starting 
one  suddenly  from  sleep ;  spasms  or  stiffness  of  the 
limbs  ;  constant  inclination  to  change  the  position  of 
the  limbs  ;  visions  ;  thirst  ;  general  sensation  of  un 
easiness  and  discontent. 

Mental  and  moral  symptoms. — Furious  mania  ;  rage  ; 
or  sadness,  despair,  and  fear  of  death. 

Pathological  anatomy. — Congestion  of  the  vessels  of 
the  brain  ;  injection  of  the  vessels  of  the  dura  mater, 
pia  mater,  and  substance  of  the  brain  with  black 
blood. 


DISEASES   OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      409 

Nux  vomica  is  suitable  for  suicidal  monomania,  at 
tended  with  great  anguish,  and  desire  to  go  from  place 
to  place  ;  also  in  nervous  hypochondria,  arising  from 
derangement  of  the  stomach  and  liver  ;  also  mental 
derangement,  arising  from  abuse  of  liquors ;  from 
mortification  ;  from  excessive  study ;  from  suppressed 
haemorrhoids.  It  is  sometimes  useful  to  remove  the 
constipation  which  is  so  frequently  present  in  insanity. 
When  there  are  frequent  and  full  pulse,  hot  and  dry 
skin,  thirst,  and  other  febrile  symptoms,  with  conges 
tion  of  blood  to  the  head,  and  a  general  exaltation  of 
the  muscular  and  mental  powers,  aconite  may  be  em 
ployed  to  remove  this  condition. 

Ignatia  is  recommended  in  melancholy  and  fixed 
mania,  occurring  in  individuals  of  a  mild  disposition, 
sad  or  cheerful,  and  occasioned  by  fright,  despair,  an 
guish,  grief,  chagrin.  A  relaxed,  exhausted,  and  feeble 
condition  of  the  body  also  requires  it. 

Pulsatilla  is  indicated  in  puerperal  melancholy,  and 
when  it  occurs  during  pregnancy,  with  anxiety,  pain  in 
the  head,  sleeplessness,  pressure  at  the  heart,  general 
uneasiness,  vague  desire  to  escape,  incoherent  talk, 
sadness  and  distrust. 

Stramonium  is  applicable  in  derangement  with 
spasmodic  symptoms  ;  in  puerperal  mania  ;  in  timid 
mania,  with  staring  look,  desire  to  escape,  screeching, 
frightful  visions,  heat,  redness  and  moisture  of  the 
skin ;  in  loquacious  mania,  with  great  mirthfulness, 
laughter,  high-flown  speeches,  and  ridiculous  motions ; 
also  in  religious  monomania,  with  great  depression  of 
spirits,  despair  of  salvation,  and  desire  to  converse 
upon  the  subject.  It  is  also  sometimes  useful  in 
"  rage,  with  furious  delirium." 

Veratrum  is  proper  in  hypochondriac,  suicidal,  and 
religious  melancholy  ;  in  puerperal  mania  ;  in  mania 
with  lewdness  and  lascivious  speeches,  and  in  some 
cases  of  furious  mania.  This  remedy  is  especially 
indicated  when  the  derangement  partakes  of  an  in 
termittent  character. 

For  the  treatment  of  suicidal  monomania,  accom 
panied  with  extreme  depression  of  spirits,  unrefresh- 
ing  sleep  from  frightful  dreams,  dread   of  some  im 
pending  calamity,  loss  of  ambition  and  energy,  dimi- 
18 


410      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

nution  of  virile  strength,  and  a  constant  disposition  to 
dwell  upon  imaginary  ailments,  muriate  of  gold  is  a 
remedy  worthy  of  the  very  highest  consideration. 
Indeed,  in  cases  of  this  description,  no  other  medicine 
can  bear  any  comparison  with  it. 

Platina  is  excellent  for  females  of  excitable  temper 
ament,  and  with  strong  sexual  desire,  It  has  cured 
melancholy,  with  great  timidity  and  depression  of 
spirits,  all  persons  seeming  to  be  demons ;  or  with 
vanity  ;  trembling  of  the  hands  and  feet  ;  anguish  at 
the  heart ;  absence  of  mind  ;  dread  of  death  ;  furor 
uterinus  ;  constipation  ;  small  and  feeble  pulse. 

There  are  other  remedies  which  may  be  consulted 
in  the  different  varieties  of  insanity,  like  the  vapours 
of  ether  and  chloroform,  the  nitrous  oxyde  gas,  &c. 
But  as  we  have  not  had  sufficient  experience  in  the 
use  of  these,  we  shall  not  now  attempt  to  point  out  the 
symptoms  which  demand  their  use. 

Administration. — As  a  general  rule,  the  above  me 
dicines  may  be  given  at  the  first  or  second  attenua 
tions,  every  twelve  or  twenty- four  hours  until  there  is 
a  medicinal  aggravation,  or  an  amelioration  of  the 
symptoms. 

SECTION  X. 

INFLAMMATION    OF   THE    SPINAL    MARROW,    AND    ITS 
MEMBRANES. 

Under  this  head  we  include  tetanus  and  hydrophobia. 

I . TETANUS. 

We  understand  by  the  term  tetanus,  sudden  morbid 
contractions  or  cramps  of  many  muscles  of  the  body, 
with  rigidity  and  loss  of  voluntary  motion  in  the  af 
fected  parts.  This  morbid  contraction  and  rigidity 
may  affect  the  muscles  of  almost  every  portion  of  the 
body,  or  it  may  be  confined  to  the  muscles  of  a  single 
part,  like  the  lower  jaw,  when  the  affection  receives 
the  name  of  trismus ;  or  to  the  extensors  of  the  back, 
giving  rise  to  recurvation  of  the  body,  when  it  is  termed 
opisthotonos  ;  or  to  those  of  the  front  part  of  the  body, 
causing  incurvation,  termed  emprosthotonos  ;  or  to  the 
muscles  of  the  side,  causing  a  lateral  curvature,  and 
called  pleurothotonos. 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      411 

Tetanus  is  much  more  common  in  hot  than  in  tem 
perate  latitudes,  and  generally  selects  for  its  victims 
individuals  of  a  nervous  and  irritable  temperament, 
or  those  whose  constitutions  have  been  impaired  by 
the  abuse  of  stimulants,  or  exposure  to  a  vitiated  at 
mosphere. 

There  are  two  varieties  of  tetanus,  the  traumatic, 
and  the  idiopathic.  The  usual  exciting  causes  of  the 
former  are,  punctured  and  lacerated  wounds,  causing 
injury  or  partial  division  of  the  nerves ;  and  of  the 
latter,  general  debility  of  the  nervous  system  from 
long  continued  illness,  or  protracted  derangement  of 
the  different  functions  of  the  organism. 

Diagnosis. — This  malady  generally  commences  with 
uneasiness  at  the  prsecordia  ;  stiffness  and  tension  in 
the  muscles  of  the  back  of  the  neck,  back,  and  loins, 
and  some  difficulty  in  deglutition  and  in  articulation. 
This  contraction  and  stiffness  gradually  increases  ; 
the  sensation  of  uneasiness  in  the  chest  becomes 
changed  to  violent  and  painful  contractions  about  the 
ensiform  cartilage  ;  the  pains  and  cramps  extend  to  the 
back,  jaws,  and  limbs  ;  the  appetite  fails  ;  the  counte 
nance  assumes  a  flushed  and  anxious  appearance  ;  the 
bowels  are  constipated  ;  the  mind  remains  sound  until 
the  last  stage  of  the  disease,  and  the  body  will  be 
rigidly  drawn  into  such  a  position  as  will  enable  us  to 
decide  what  particular  class  of  muscles  are  affected, 
and  which  of  the  varieties  of  tetanus  is  present. 

Traumatic  tetanus  is  always  a  dangerous  affection, 
but  hopes  of  cure  may  be  entertained  when  unusual 
pains  in  the  wound  or  cicatrix,  with  pains  extending 
along  the  limbs  in  the  direction  of  the  contracted 
parts,  occur  simultaneously  with  the  first  symptoms  of 
the  complaint.  But  if  the  symptoms  continue  to  make 
steady  progress,  while  the  original  wound  is  cicatrized, 
and  no  pain  or  disturbance  is  experienced  either  at 
this  point,  or  extending  from  it,  the  case  may  be 
looked  upon  as  highly  dangerous. 

Idiopathic  tetanus  proceeds  from  constitutional 
causes,  and  is  far  less  dangerous  than  the  traumatic 
variety.  Its  approach  is  also  more  gradual,  and  at 
tended  with  less  pain,  but  when  the  contraction  and 
rigidity  of  the  parts  take  place,  they  remain  in  this 


412     DISEASES    OF    THE    BRAIN    AND    JJKRVOUS    SYSTEM. 

condition  a  longer  time  than  in  the  other  form  of  the 
disease.  The  violent  contractive  pains  about  the  en- 
siform  cartilage,  and  in  the  nape  of  the  neck,  which 
are  so  characteristic  of  traumatic  tetanus,  are  also 
absent  in  this  variety.  Indeed,  we  have  seen  cases 
where  no  pains  or  uneasy  sensations  were  experienced 
in  any  part  of  the  body,  except  from  the  constrained 
positions  of  the  parts  affected  with  the  morbid  con 
traction. 

Causes. — Punctured  and  lacerated  wounds,  which 
partially  divide  one  or  more  nerves,  is  one  of  the  most 
common  causes.  The  admission  of  cold  air  into 
wounds,  sudden  check  to  the  perspiration  after  long 
and  fatiguing  exercise  under  a  hot  sun,  the  irritations 
of  splintered  bones,  or  other  foreign  substances  in 
contact  with  nerves  and  tendons,  amputations,  and 
blows  upon  the  spine,  are  all  occasional  causes  of 
traumatic  tetanus. 

The  exciting  causes  of  idiopathic  tetanus  are,  sup 
pressed  menstruation,  or  other  habitual  discharge, 
low  fevers,  over-exertion  of  mind  or  body,  too  close 
confinement  in  small  and  ill  ventilated  apartments, 
sitting  in  unnatural  and  constrained  positions,  tight 
lacing. 

Therapeutics. — A  preliminary  step  in  the  treatment 
of  tetanus,  should  always  be  to  remove,  as  far  as  pos 
sible,  whatever  causes  may  have  operated  towards 
inducing  the  disease,  or  which  may  continue  to  exert 
an  irritating  effect  after  its  full  formation.  The  causes 
of  this  character  arc,  the  presence  of  irritating  spicula 
of  bone,  of  needles,  of  dirt,  of  rust,  or  any  other  for 
eign  substance,  in  contact  with  the  nerves  and  ten 
dons  ;  abuse  of  stimulants,  the  wearing  of  too  tight 
clothing,  foul  air,  exposure  to  sudden  changes  of  tem 
perature,  especially  from  intense  heat  to  coldness  and 
humidity.  When  there  is  reason  to  suspect  the  pre 
sence  of  a  foreign  body  in  a  cicatrized  wound,  after 
the  appearance  of  tetanic  symptoms,  we  should  at 
once  cut  down  and  endeavour  to  extract  the  obnoxious 
substance  ;  and  in  case  nothing  can  be  found,  to  apply 
spirits  of  turpentine,  or  some  escharotic,  in  order  to 
ensure  suppuration  in  the  wound.  This  important 
surgical  resource  should  always  be  resorted  to  in 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.     413 

cases  of  this  description,  for  it  is  not  an  uncommon 
occurrence  to  perceive  the  immediate  disappearance  of 
incipient  tetanic  symptoms,  on  the  removal  of  a  for 
eign  substance  from  the  wounded  part. 

The  remedies  most  appropriate  in  the  treatment  of 
tetanus,  are,  nux  vomica,  belladonna,  arnica,  stramo 
nium,  cicuta,  hyoscyamus,  opium,  pulsatilla,  sulphur. 

Nux  vomica,  from  its  decidedly  specific  action  upon 
the  spinal  marrow,  and  its  membranes,  as  well  as 
from  its  pathogenesis,  and  the  appearance  of  individ 
uals  who  have  been  poisoned  with  it,  is  evidently  a 
remedy  of  importance  in  this  dangerous  malady.  It 
is  especially  called  for  when  the  spasms  are  frequent 
and  short,  consciousness  is  perfect,  and  there  are 
cramp-like  pains  in  the  region  of  the  stomach,  con 
stipation,  and  loss  of  appetite,  and  when  the  patient 
has  been  addicted  to  the  abuse  of  stimulants. 

Belladonna,  succeeded  by  pulsatilla,  may  be  given 
in  idiopathic  tetanus  which  has  arisen  from  deranged 
menstruation,  or  other*  causes  connected  with  the 
utero-genital  system,  and  where  the  extremities  are 
for  the  most  part  affected  with  the  morbid  contrac 
tions.  It  may  also  be  sometimes  given  in  the  last 
stages  of  traumatic  tetanus,  when  there  is  delirium, 
dilated  pupils,  and  great  mental  anguish. 

Arnica  should  be  used  both  internally  and  exter 
nally,  in  all  injuries  which  threaten  to  lead  to  tetanus. 
This  remedy  possesses  the  power  of  warding  it  off, 
when  it  might  otherwise  have  occurred  without  its 
use,  and  should  always  be  resorted  to  when  danger  is 
anticipated  from  a  wound. 

When  we  find  great  rigidity  of  the  extremities, 
contraction  of  the  thumbs  or  fingers,  wild  and  fixed 
look,  painful  and  difficult  respiration  and  deglutition, 
we  may  give  stramonium  in  alternation  with  hyoscya 
mus  or  cicuta. 

Many  writers  speak  in  favourable  terms  of  warm 
baths  in  the  treatment  of  this  affection.  We  have 
seen  the  most  unequivocal  advantage  follow  general 
bathing,  and  a  thorough  application  of  fomentations 
to  the  affected  parts,  and  to  the  spine.  We  can  call 
to  mind  two  cases  where  life  was  apparently  saved 
by  the  persevering  application  of  these  hot  fomenta- 


414     DISEASES    OF   THE    BRAIN    AND    NERVOUS    SYSTEM. 

tions,  together  with  frictions  along  the  course  of  the 
spine. 

We  take  occasion  in  this  place  to  suggest  to  the 
profession  the  use  of  the  saliva  of  rabid  animals  as  a 
remedy  in  this  affection.  It  has  been  found  by  Majen- 
die  and  Brechet,  that  if  this  saliva  be  introduced  un 
der  the  skin,  or  into  the  blood  of  animals,  that  the 
animal  so  impregnated  contracts  the  hydrophobia. 
Why  should  it  not  then  be  employed  in  those  maladies 
which  are  characterized  by  symptoms  similar  to  those 
of  rabies? 

Other  medicines  which  may  demand  attention  are, 
veratrum,  moschus,  phosphorus,  china,  ignatia,  lachesis, 
acid  hydrocyanic,  camphor,  plumbum. 

Administration. — We  advise  from  the  third  to  the 
sixth  attenuations  in  this  affection — a  dose  every  hour 
until  the  system  responds  in  a  satisfactory  manner, 
after  which  we  must  be  governed  by  circumstances. 

2. HYDROPHOBIA. 

The  term  hydrophobia,  or  dread  of  water,  is  given 
to  that  dreadful  malady  which  follows  the  bite  of  a 
rabid  animal,  and  the  introduction  of  its  saliva  into 
the  blood.  A  dread  of  water  is  commonly  a  promi 
nent  and  characteristic  symptom  of  the  disease,  but  it 
is  by  no  means  one  which  is  invariably  present.  Cases 
are  reported  by  Hunter,  Frank,  and  Eberle,  in  which 
no  unpleasant  consequences  followed  the  use  of  drinks, 
from  the  commencement  to  the  fatal  termination  of 
the  disorder.  We,  ourselves,  have  seen  a  rabid  dog 
that  would,  without  hesitation,  plunge  into  water  and 
drink  during  the  whole  course  of  the  disease,  without 
exciting  spasmodic  contractions,  or  any  other  disagree 
able  symptom. 

Rabies  originates  spontaneously  in  animals  of  the 
canine  species,  like  the  dog,  the  fox,  the  wolf,  &c.,  and 
appears  to  consist  of  a  morbid  deterioration  of  the 
saliva.  The  precise  nature  of  this  deterioration,  or  of 
the  specific  poison  which  this  fluid  contains,  is  at  pre 
sent  entirely  unknown  ;  but  in  regard  to  its  specific 
action  upon  some  portion  of  the  nervous  centres,  there 
remains  no  doubt,  although  morbid  anatomists  have 
hitherto  failed  to  detect  the  peculiar  diseased  appear- 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      415 

ances  to  which  it  gives  rise.  Perhaps  this  may  be  ac 
counted  for  when  we  call  to  mind  the  proneness  of 
pathologists  to  regard  congestion  of  the  blood-vessels, 
redness,  effusion,  softening,  or  induration,  as  the  only 
morbid  appearances  indicative  of  previous  disease, 
while  in  point  of  fact,  if  we  may  trust  the  pathological 
investigations  of  Dr.  Hugh  Bennett,  by  means  of  the 
microscope,  "  important  changes  may  take  place  in  the 
cerebral  substance,  spinal  marrow,  &c.,  inappreciable 
to  the  naked  eye,  but  clearly  discernible  with  the 
microscope." — (Ed.  Med.  and  Surg.  Jour.,  vol.  58,  p. 
58  and  60." 

The  redness  of  the  fauces  and  oesophagus  which  is 
often  observed  in  men  and  animals  dead  of  hydropho 
bia,  is  attributable  rather  to  the  irritation  consequent 
upon  the  intense  and  unindulged  thirst  which  was  pre 
sent  during  the  attack,  than  to  any  specific  action  of 
the  virus  upon  these  parts. 

The  virus  of  rabies  is  formed  and  is  active,  for 
the  most  part,  in  the  saliva,  but  a  sufficient  quantity  is 
absorbed  into  the  general  circulation  to  produce  the 
morbid  impression  upon  the  spinal  marrow  which  con 
stitutes  the  chief  fact  of  the  disease.  Could  we  con 
fine  the  virus  to  the  saliva  of  the  mouth,  and  prevent 
its  admission  into  the  circulation,  no  evil  effects  would 
result ;  but  place  the  smallest  quantity  in  a  position 
where  absorption  can  take  place,  and  it  will  be  con 
veyed  with  unerring  certainty  to  the  part  which  pos 
sesses  a  specific  affinity  for  it,  and  there  produce  its  le 
gitimate  morbid  impression. 

Some  writers  suppose  that  the  poison  does  not  enter 
the  general  circulation,  because  the  N.  American  In 
dians,  the  inhabitants  of  the  country  of  Mantone,  &c.t 
often  eat  the  flesh  of  hydrophobic  animals  with  im 
punity  ;  but  this  proves  nothing,  for  the  lacteals  and 
absorbents  of  the  digestive  apparatus,  reject  this  sub 
stance  as  an  irritant,  and  it  is  carried  off  with  the  fae 
ces,  without  producing  any  impression. 

Mclntosh  believes  that  tetanus  is  often  mistaken  for 
hydrophobia,  when  dread  of  liquids  is  one  of  the 
symptoms  of  the  former  ;  and  when  we  reflect  that  the 
teeth  of  dogs  usually  inflict  such  punctured  or  lacerated 


416      DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM. 

wounds,  as  often  give  rise  to  tetanus,  the  opinion  seems 
plausible. 

Hydrophobia  usually  makes  its  appearance  in  from 
twenty  to  sixty  days  after  the  bite,  although  well  au 
thenticated  cases  are  recorded  in  which  the  virus  has 
remained  dormant  in  the  system  for  years,  when  it  has 
finally  developed  itself  from  some  constitutional  dis 
turbance,  and  the  patient  has  succumbed  with  all  the 
symptoms  of  hydrophobia. 

Diagnosis. — At  an  uncertain  period,  varying  from 
three  to  nine  weeks  from  the  reception  of  the  wound,  the 
first  symptoms  of  hydrophobia  make  their  appearance, 
usually  in  the  bitten  part,  which  presents  a  livid  and 
slightly  swollen  appearance,  and  attended  with  burn 
ing  heat  or  shooting  pains  which  dart  from  the  seat  of 
the  injury  to  the  neighbouring  parts.     These  symp 
toms  are  speedily  succeeded  by  rigours,  lassitude,  great 
depression  of  spirits,  anxiety,  watchfulness,  irritability, 
giddiness  ;  eyes  red,  brilliant  and  sensitive  to  light,  un 
easy  sensations  at  the  stomach,  tension  at  the  chest, 
difficulty  of  deglutition,  and  slightly  oppressed  respi 
ration.     As  the  disease  advances,  the  cramps  about 
the  throat,  neck,  and  chest,  become  more  and  more  vio 
lent,  until  the  mere  sight  of  a  liquid,  or  of  a  shining  sub 
stance,   will  produce   the   most   painful   paroxysms : 
there  is  a  viscid  saliva  constantly  secreted  which  com 
pels  the  victim  to  be  continually  spitting,  while  at  the 
same  time  he  is  tormented  with  a  dryness  in  the  mouth 
and  throat,  and  an  intense  thirst,  which  he  is  unable 
to  allay,  on  account  of  the    spasmodic  contractions 
which  occur  whenever  drinks  are  presented  to  him. 
The  skin  is  hot  and  dry,  the  cicatrix  opens  and  pre 
sents  an  unhealthy  appearance,  the  respiration  be 
comes  more  and  more  difficult,   the  voice   becomes 
changed,  the  pulse  nearly  natural,  the  body  affected 
with  tremours  or  slight  spasmodic  twitchings,  vague 
pains  extend  up  from  the  lower  part  of  the  spine  to 
the  head,  and  finally  the  countenance  becomes  pale 
and  haggard,  the  eyes  sunken  yet  still  brilliant,  there 
are  palpitation  of  the  heart,  wandering  delirium,  con 
stant  inclination  to  bite,  extreme  anxiety  and  uneasi 
ness,  sinking  of  the  pulse,  loss  of  voice,  clammy  sweat, 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      417 

and  finally,  the  sufferer  sinks  into  a  lethargy,  or  into 
convulsions,  and  dies. 

The  disease  commonly  terminates  in  from  two  to 
eight  days  from  its  first  approach. 

Therapeutics. — The  most  certain  preventive  means 
after  the  bite  of  a  rabid  animal,  is  to  excise  imme 
diately  and  thoroughly,  the  wounded  part.  This  se 
vere  measure  can  only  prove  available  unless  resorted 
to  within  a  very  short  period — say  fifteen  or  twenty 
minutes  after  the  infliction  of  the  bite.  If  a  longer  time 
than  this  has  elapsed,  we  should  advise  free  incisions  up 
on  the  wounded  points,  and  after  they  have  bled  freely, 
and  been  suitably  washed  and  cleansed,  the  applica 
tion  of  the  caustic  alkali.  Some  surgeons  speak  in 
high  terms  of  the  application  of  the  red-hot  iron,  of 
the  butter  of  antimony,  of  corrosive  sublimate,  of  chlo 
ride  of  zinc,  &c.  ;  but  in  my  opinion,  the  prompt  use 
of  the  knife,  and  of  caustic  potash,  will  prove  more 
efficient  and  less  painful  than  the  other  applications. 
Nor  do  I  give  this  advice  from  theory  alone,  for  I 
had  occasion,  some  five  years  since,  to  test  the  practical 
operation  of  these  severe  measures  upon  my  own  per 
son.  In  July,  1844,  I  was  bitten  in  the  leg,  without 
'provocation,  by  a  dog  which  came  tearing  past  me  at 
a  furious  rate,  with  fierce  and  brilliant  expression  of 
the  eyes,  tail  pendant  between  the  legs,  foam  at 
the  mouth,  and  hair  standing  erect  upon  the  back. 
Without  any  delay,  I  excised  the  bitten  part,  and 
applied  the  caustic  potash  to  the  wound,  in  the  most 
thorough  manner  ;  after  which,  1  dressed  and  bound 
up  the  limb,  congratulating  myself  on  my  prompt 
ness,  and  probable  escape  from  this  most  dreadful  ma- 
lad}".  Inquiries  were  now  instituted  to  ascertain 
something  respecting  the  course  and  the  whereabouts 
of  the  "  mad  dog,"  when  to  my  surprise,  and  indeed 
I  may  say  indignation,  1  was  informed  that  the  ani 
mal  was  not  rabid,  but  "dreadful  ugly."  The  course 
adopted,  however,  was  a  prudent  and  safe  one,  and  I 
should  most  certainly  do  the  same  again  under  similar 
circumstances,  on  the  principle  "that  an  ounce  of  pre 
vention  is  worth  a  pound  of  cure."  As  the  matter  ac 
tually  turned  out,  I  was  tormented  with  a  painful  limb 
for  two  or  three  months  unnecessarily  ;  but  had  the 

]8* 


418      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

animal  proved  to  have  been  rabid,   then   the   result 
would  have  been  the  saving  of  my  life. 

No  specific  has  yet  been  discovered  for  the  cure  of 
hydrophobia,  although  many  articles  have  been  at  dif 
ferent  periods  brought  into  notice  by  the  old  school, 
as  for  example,  mercury,  burnt  lichen,  and  black  pepper, 
the  purple-flowered  anagallis,  oil  of  valerian,  opium, 
musk,  ignatia,  camphor,  cantharides,  stramonium,  nux 
vomica,  and  belladonna. 

Professor  Munch  has  given  the  last  named  medicine 
to  several  who  had  been  bitten  by  rabid  dogs,  and  not 
one  was  attacked  with  rabies.  Hahnemann  also  ad 
ministered  it  with  success,  both  as  a  prophylactic  and 
as  a  curative  remedy. 

In  consulting  the  pathogenesis  of  belladonna,  we  find 
amongst  the  most  prominent  symptoms  to  which  it 
gives  rise,  are  dryness  and  constriction  of  the  mouth 
and  fauces,  accumulation  of  a  tough  mucus  about 
the  mouth,  deglutition  difficult  or  even  impossible,  in 
jected  and  glassy  eyes,  articulation  difficult,  voice 
changed,  giddiness,  trembling  and  weakness  of  the 
whole  body  ;  mouth  and  jaws  spasmodically  affected, 
intense  thirst,  nausea,  and  finally,  previous  to  death, 
"  a  feeble  pulse,  cold  extremities,  subsultus  tendinum, 
tremours,  deep  coma  or  delirium,  and  sometimes  con 
vulsions/' 

From  the  above  description,  it  is  apparent  that  this 
medicine  induces  a  close  correspondence  to  the  most 
marked  symptoms  of  hydrophobia,  and  therefore  it  is 
entitled  to  our  earnest  consideration,  when  called  to 
cases  of  this  description. 

When  the  disease  is  fully  formed,  and  there  are,  se 
vere  convulsions,  with  sense  of  impending  suffocation, 
dryness  of  the  mouth  and  fauces,  extreme  difficulty 
of  deglutition,  dread  or  horror  even  at  the  sight  of 
liquids,  delirium,  rage,  and  fury,  we  may  likewise 
consult  stramonium,  nux  vomica,  hyoscyamus,  lachesis, 
cantharides,  and  veratrum. 

The  medicines  may  be  administered  in  the  same 
manner  as  advised  in  tetanus 


DISEASES    OP    THE    BRAIN    AND    NERVOUS    SYSTEM.      419 


SECTION  XL 

CHOREA. 

Chorea  occurs,  for  the  most  part,  in  girls  of  feeble 
constitutions  and  of  irritable  nervous  temperaments, 
and  between  the  ages  of  five  and  fourteen.  The  dis 
ease  is  recognised  by  almost  constant  involuntary 
movements  of  the  muscles  affected,  while  in  the  wak 
ing  state,  either  with  or  without  derangement  of  the  in 
tellect.  From  its  resemblance  to  raphania,  it  has  been 
sometimes  confounded  with  it.  It  also  presents  many 
marks  of  similarity  to  epilepsy  and  hysteria,  and  is 
probably  somewhat  analogous  to  these  maladies  in  its 
location  and  nature.  The  affection  is  not  usually  at 
tended  with  danger,  and  terminates  at  the  period  of 
puberty ;  but  when  it  has  existed  for  a  number  of  years, 
accompanied  by  perversion  of  the  intellectual  facul 
ties,  permanent  idiocy,  or  at  least  an  impaired  under 
standing,  may  result.  Finally,  the  disease  may  oc 
casionally  occur  at  any  period  of  life,  and  in  indivi 
duals  of  both  sexes. 

Diagnosis. — Generally,  for  months  previous  to  the 
occurrence  of  the  involuntary  motions  which  charac 
terize  this  disease,  it  will  be  found  that  the  child  has 
suffered  from  constipation,  oppression  in  the  region  of 
the  stomach  and  chest,  vertigo,  and  other  bad  feelings 
in  the  head,  appetite  morbidly  increased  or  depressed, 
occasional  flushes  of  fever  during  the  night,  palpita 
tion  of  the  heart,'  nervousness,  irritability,  and  coldness 
of  the  feet.  The  involuntary  motions  commence  by 
slight  twitchings  in  the  muscles  of  the  face,  which  soon 
become  strongly  pronounced  and  extend  to  a  greater 
or  less  extent  to  other  parts  of  the  body,  as  one  en 
tire  side,  or  one  arm  or  leg.  When  the  limbs  are  af 
fected,  the  walk  becomes  awkward  and  unsteady,  and 
the  arms  fail  to  obey  the  commands  of  the  will,  while 
involuntary  gestures  and  motions  are  continually  made 
without  reason  or  point,  thus  causing  the  individual 
to  present  a  most  ludicrous  appearance.  The  patient 
may  remain  in  this  condition  for  years,  without  the 
occurrence  of  any  other  serious  consequences,  unless 
the  intellect  becomes  impaired,  when  a  total  loss  of 


420       DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

mind  may  result.  Some  cases  are  attended  with  diffi 
cult  respiration,  dysuria,  vague  pains  in  the  limbs, 
confusion  of  ideas,  and  failure  of  memory. 

Causes. — A  naturally  delicate  constitution  or  one 
which  has  been  impaired  by  abuse  of  medicines,  and  a 
nervous  temperament,  are  conditions  most  favourable 
to  the  production  of  chorea.  Probably,  the  most  fre 
quent  exciting  cause  is  the  repercussion  of  some 
chronic  cutaneous  eruption.  Many  facts  are  on  re 
cord  which  go  to  prove  this  ;  as,  for  example,  the 
cases  cited  by  Hahnemann,  Stapf,  Pouchet,  Frank, 
&c.,  where  the  malady  has  arisen  in  consequence  of 
sudden  drying  up  of  tetter,  plica  polonica,  herpes, 
scald-head,  psora,  or  some  habitual  discharge.  Other 
exciting  causes  are,  the  depressing  passions,  fear  and 
terror,  masturbation,  irritation  of  the  bowels  from 
worms  and  faecal  accumulations,  cold,  insufficient 
nutriment,  and  excessive  loss  of  blood. 

Therapeutics. — In  all  cases  of  chorea  the  patient 
should  be  removed  to  the  country,  where  she  may  en 
joy  pure  and  salubrious  air,  abundant  exercise,  and  a 
plain,  but  highly  nutritious  regimen. 

The  remedies  for  chorea  are,  stramonium,  belladonna, 
cuprum  acetat,  sulphur,  calcarea  carb.,  hyoscyamus,  rhus, 
nux  vomica,  ignatia.  lycopodium,  phosphorus,  china, 
ferrum. 

If  the  disease  has  been  caused  by  fright  or  terror, 
and  we  find  great  contortions  of  the  face,  eyes,  and 
limbs,  head  thrown  back,  or  drawn  frequently  to  the 
left  side,  oppressed  respiration,  wild  and  staring  ex 
pression,  convulsive  laughter  or  weeping,  restless 
ness,  convulsive  twitchings  of  the  muscles,  anxiety, 
pale  face,  features  sunken,  small  pulse,  and  delirium, 
we  may  select  one  of  the  following  medicines  :  stramo 
nium,  belladonna,  hyoscyamus,  and  ignatia. 

When  the  symptoms  have  followed  the  drying  up  of 
chronic  cutaneous  eruptions,  cuprum  acetate,  sulphur  and 
lycopodium,  will  be  called  for  ;  if  they  have  set  in  after 
measles,  calcarea  carb.  is  proper  ;  if  the  cause  can  be 
traced  to  t>nam&tti,pho3pkorU8  and  china  are  applicable ; 
if  they  have  arisen  from  constipation,  and  collections 
of  faecal  matter  in  the  intestines,  nux  vomica  and  sul 
phur-are,  the  best;  remedies  ;  if  the  malady  has  been 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.        421e 

induced  by  excessive  loss  of  blood,  or  by  general  de 
bility,  we  advise,  ferrum,  china,  acid  phosph.,  acid 
nitr.,  and  rhus  toxicodendron. 

Administration.  —  In  chorea,  the  whole  nervous  sys 
tem  is  in  a  morbidly  impressible  condition,  and  will 
generally  respond  readily  to  the  higher  attenuations. 
We  usually  commence  with  the  twelfth  dilutions,  and 
administer  a  dose  once  or  twice  daily,  until  a  suitable 
impression  is  made  upon  the  symptoms. 

SECTION    XII. 

HYSTERIA. 

Sydenham,  Stahl,  Van  Swieten,Sprengel,  and  Frank, 
regard  hysteria  and  hypochondria  as  substantially  the 
same  affection.  The  two  maladies  unquestionably 
bear  a  very  close  resemblance  to  each  other  in  many 
respects  ;  as,  for  example,  the  almost  infinite  variety 
and  similarity  of  the  symptoms  which  they  present, 
and  the  proneness  of  the  subjects  of  both  diseases  to 
exaggerate  trivial  or  even  imaginary  ailments  into 
disorders  of  magnitude. 

But  there  are  marks  of  distinction  between  them 
equally  important,  which  refute  conclusively  the  opi 
nion  respecting  their  identity. 

Pure  hypochondria  almost  invariably  occurs  in  in 
dividuals  of  a  lymphatic  and  bilious  temperament. 
Their  dispositions  are  generally  gloomy  and  morose, 
find  ever  inclining  to  "  look  on  the  dark  side."  Hope, 
confidence,  cheerfulness,  enter  but  sparingly  into  their 
dispositions  ;  they  are  not  addicted  to  "  building 
castles  in  the  air  ;"  never  behold  anything  bright, 
agreeable,  or  desirable  in  the  future  ;  but,  looking 
with  distrust  and  aversion  upon  mankind,  and  obsti 
nately  fixing  their  thoughts  upon  some  dreadful  im 
pending  calamity,  which  they  are  sure  will  overtake 
them  sooner  or  later,  they  either  drag  out  a  miserable 
existence,  suffering  mentally  almost  every  evil,  or 
terminate  their  woes  by  suicide. 

Hysteria,  on  the  contrary,  usually  occurs  in  females 
of  a  nervous,  or  nervous-sanguine  temperament,  with 
cheerful,  lively,  and  ardent  dispositions,  vivid  imagi 
nations,  and  highly  impressible  organizations. 


UNIVERSITY  / 

/ 


422   DISEASES  OF  THE  BRAIN  AND  NERVOUS  SYSTEM. 

Hypochondria  is  uniform  and  continuous  in  its 
course,  and  presents  but  slight  variations  from  day  to 
day.  Hysteria  occurs  in  paroxysms,  with  intervals  of 
greater  or  less  duration,  of  passable  bodily  health  and 
excellent  spirits. 

Hypochondria  is  always  connected  with  disorder  of 
the  stomach  and  liver.  Hysteria  is  owing  to  an  irri 
tation  or  erethism  of  the  whole  nervous  system. 

Writers  have  always  regarded  the  seat  of  hysteria 
as  in  the  uterine  and  sexual  organs,  because  it  has  usu 
ally  been  associated  with  derangement  of  the  functions 
of  these  organs.  It  occurs  after  the  period  of  puberty, 
in  females  of  a  nervous,  or  nervous-sanguine  tempera 
ment,  with  strong  sexual  propensities,  and  is  accom 
panied  with  deranged  menstruation,  dysuria,  sexual 
excitement,  or  pains  in  the  pelvic  region.  Yet  the 
malady  is,  in  my  opinion,  one  of  a  purely  nervous 
character,  consisting  of  an  erethism  of  the  whole 
nervous  system,  and  capable  of  being  brought  into  ac 
tive  operation  by  any  exciting  cause  which  may  ope 
rate  upon  the  economy,  like  deranged  menstruation, 
the  depressing  emotions,  fright,  terror,  mortification, 
dread,  chagrin,  disappointed  love,  undue  excitement  of 
the  sexual  organs,  &c. 

This  peculiar  irritable  condition  of  the  nervous 
system  may  exist  for  an  indefinite  length  of  time, 
without  any  actual  development  of  proper  hysteric 
symptoms,  provided  the  above  named  exciting  causes 
do  not  operate. 

Diagnosis. — Sometimes  the  first  symptoms  of  hyste 
ria  are  flatulency,  pains,  or  distressing  sensations  in 
the  stomach,  bowels,  chest,  head,  and  back  ;  faintness, 
vertigo,  bitter  taste,  eructations,  dysury,  anxiety,  de 
pression  of  spirits,  difficulty  of  breathing,  sense  of  suf 
focation  from  something  like  a  ball  rising  in  the 
throat,  (or  globus  hystericus),  ringing  in  the  ears,  deli 
rium,  or  loss  of  consciousness.  Symptoms  of  this  kind 
take  place  in  individuals  of  a  feeble  and  purely  ner 
vous  temperament,  and  the  delirium  and  loss  of  con 
sciousness  appear  to  take  the  place  of  convulsions. 

In  others,  of  a  nervous-sanguine  temperament,  with 
robust  constitutions,  the  convulsive  paroxysms  come 
on  by  slight  twitehinsfs  of  the  muscles  of  the  mouth 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.        423 

and  eyes,  with  wild  expression,  eyes  rolled  up,  con 
vulsive  laughing,  crying,  or  sobbing,  constant  attempts 
to  pull  out  the  hair,  to  strike  the  breast  or  some  other 
part,  and  to  bite  ;  difficult  and  laborious  respiration, 
succeeded  in  a  short  time  by  the  most  violent  con 
vulsions.  ; 

In  other  instances  the  paroxysms  are  preceded  by  a 
croupy-cough,  or  colic  pains,  or  pains  in  the  head, 
chest,  back,  or  pelvis. 

In  some  cases  the  paroxysm  takes  place  suddenly, 
without  any  warning  symptoms,  and  the  patient  may 
suffer  a  series  of  dreadful  convulsions,  with  only  brief 
intervals  of  consciousness,  for  many  hours,  and  then 
be  restored  speedily  to  all  her  mental  and  bodily 
faculties. 

It  would  be  useless  to  attempt  a  detail  of  all  the 
phenomena  which  may  occur  in  hysteria,  and  we  shall 
in  conclusion  only  observe,  that  the  peculiar  condition 
of  the  nervous  system  upon  which  the  disease  is  de 
pendent,  and  the  convulsive  paroxysms  to  which  this 
morbid  state  gives  rise,  should  command  our  principal 
attention  in  the  treatment  of  the  malady. 

Causes. — The  predisposing  causes  are,  a  delicate, 
nervous  temperament,  too  much  confinement  in  close 
and  heated  apartments,  the  frequent  perusal  of  excit 
ing  works  of  fiction,  attendance  on  theatrical  exhibi 
tions,  tight  lacing,  want  of  exercise,  premature  task 
ing  of  the  mind  to  the  neglect  of  the  body,  habitual  in 
dulgence  in  lascivious  thoughts,  nervousness,  luxu 
rious  living. 

Amongst  the  exciting  causes  may  be  mentioned, 
violent  mental  impressions  of  any  kind,  whether  pro 
duced  by  the  sight  of  disagreeable  objects,  or  the  smell 
of  disagreeable  odours,  or  the  hearing  of  sudden  noises, 
discordant  sounds,  or  by  terror,  fright,  anger,  rage, 
grief,  chagrin,  mortification,  and  disappointed  love  or 
ambition. 

Hamilton  supposes  the  presence  of  irritating  and 
indigestible  substances  in  the  intestines  is  a  common 
exciting  cause  of  hysteria. 

Other  exciting  causes  are,  sudden  suppression  of 
the  menstrual  discharge,  too  profuse  evacuations,  and 
Irneorrhoea. 


424        DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

Therapeutics.-—  For  the  cure  of  hysteria  arising  from 
a  torpid  state  of  the  bowels,  and  an  accumulation  of 
undigested  faecal  matter,  and  attended  with  putrid  or 
sour  taste,  bitter  or  acid  eructations,  flatulency,  ful 
ness,  distention  and  pain  in  the  epigastrium,  con 
stipation,  nausea,  weakness,  languor,  faintness,  head 
ache,  giddiness,  confusion  of  ideas,  strong  tendency  to 
convulsions,  nux  vomica  and  sulphur  are  the  proper 
remedies. 

When  the  attacks  appear  to  have  been  excited  by 
derangement  of  the  uterine  functions,  the  most  suit 
able  remedies  will  be  pulsatilla,  sabina,  and  silicea. 

If  the  exciting  cause  has  been  terror,  fright,  anger, 
disappointment;  mortification,  or  any  violent  mental 
excitement,  ignatia,  hyoscyamus,  aurum,  belladonna, 
cojfea,  will  each  cover  most  of  the  symptoms. 

Administration. — The  remedies  should  be  adminis 
tered  at  the  third  dilution,  during  the  paroxysm,  by 
placing  a  drop  upon  the  tongue  at  short  intervals,  or 
by  smelling ;  but  during  the  intervals,  a  drop  once 
in  twelve  hours,  until  the  desired  impression  is  pro 
duced. 

SECTION  XIII. 

NEURALGIA. 

By  the  term  neuralgia,  we  designate  all  of  those 
painful  affections,  in  different  parts  of  the  body,  of  a 
purely  nervous  character.  This  disease  may  attack 
every  system  of  nerves,  and  every  structure  of  the  or 
ganism,  whether  external  or  internal.  Different 
names  have  been  given  to  it,  derived  from  the 
particular  structures  affected,  but  as  the  real  na 
ture  of  the  disease  is  always  the  same,  in  whatever 
part  it  may  be  located,  and  as  the  points  of  its  attack 
are  almost  innumerable,  there  is  a  manifest  difficulty 
and  impropriety  in  endeavouring  to  effect  a  minute 
classification.  The  most  common  seat  of  neuralgia 
is  in  the  first,  second  and  third  branches  of  the  fifth 
pair  of  nerves,  and  in  the  portio-dura.  When  the  dis 
ease  is  confined  to  the  facial  portions  of  these  nerves,  it 
is  recognised  under  the  name  of  tic  douloureux ;  when 
its  location  is  in  the  nerves  of  the  stomach, gastrodinia  ; 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      425 

when  in  the  first  branch  of  the  fifth  pair  of  nerves, 
nervous  headache ;  when  in  the  nerves  of  the  feet  and 
legs,  neuralgia  pedis  ;  when  in  those  of  the  mammae, 
neuralgia  mammce ;  when  to  those  of  the  heart,  angina 
pectoris,  &c.  But  as  these  various  names  only  tend 
to  complicate  our  classification,  and  render  com 
plex  what  is  in  reality  simple,  we  shall  treat  of  all 
these  nervous  attacks  under  the  general  appellation  of 
neuralgia. 

Diagnosis. — The  following  are  the  general  charac 
teristics  of  neuralgia  :  sudden  paroxysms  of  exceed 
ingly  acute  pain  in  some  particular  nerve,  with  vio 
lent  lancinating  pains  extending  along  the  ramifica 
tions  of  the  nerve  in  different  directions,  attended  with 
turgescence  of  the  blood  vessels  in  the  vicinity  of  the 
part  chiefly  affected,  but  without  fever.  The  pains 
are  so  sudden  and  severe  as  to  resemble  electric  shocks, 
and  they  often  give  rise  to  spasmodic  contortions  or 
twitchings  of  th-e  muscles  of  the  face  when  the 
branches  of  the  fifth  and  the  facial  branch  of  the 
seventh  pair  of  nerves  are  the  seat  of  the  pains.  The 
pains  are  sometimes  aggravated  by  the  slightest  move 
ment,  or  by  the  gentlest  touch,  although  firm  pressure 
causes  no  pain.  The  particular  nerve  or  nerves  in 
volved,  can  always  be  pointed  out  with  exactness, 
because  the  principal  seat  of  the  attack  is  always  in 
some  portion  of  a  nerve,  and  radiates  thence  along 
its  different  ramifications  ;  and  from  this  circumstance 
surgeons  have  occasionally  excised  with  success  por 
tions  of  nervous  trunks  to  effect  cures  ;  but  this  severe 
measure  should  never  be  resorted  to,  when  suitable 
homoeopathic  specifics  can  be  so  readily  procured. 

In  facial  neuralgia,  there  are  often  lachrymation  ; 
increased  flow  of  saliva  ;  spasmodic  twitchings  of  the 
mouth,  cheeks,  and  eyelids  ;  spasmodic  closing  of  the 
eyelids  ;  unusual  heat  and  tension  in  the  side  affected  ; 
stiffness  in  the  jaw  and  neck  ;  increase  of  pain  by 
light,  noise,  motion,  touch,  talking,  or  eating  ;  heat  or 
coldness  of  the  body  ;  vertigo  ;  and  confusion  of 
ideas. 

When  the  head  is  the  seat  of  the  attack,  we  may 
have  violent  periodical  pains  in  some  part  of  the  head, 
darting  along  the  nervous  ramifications;  nausea; 


426      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

vomiting  ;  extreme  sensitiveness  to  the  touch,  cold  air, 
sounds  and  light ;  humming  in  the  ears  ;  sense  of  heat 
and  fulness  in  the  affected  part  ;  floats  before  the  eyes 
on  the  slightest  attempt  to  use  them  ;  aversion  to 
food  ;  confusion  of  ideas ;  disinclination  to  converse, 
or  to  listen  to  others. 

When  neuralgia  affects  the  superior  or  inferior 
extremities,  back  or  mammaB,  the  symptoms  will 
be  fewer  on  account  of  the  less  number  of  sympathetic 
connections  existing  between  these  parts.  In  these 
instances,  the  violent  lancinating  pains,  occurring  in 
paroxysms,  and  increased  by  the  slightest  contact,  and 
by  motion,  and  unaccompanied  with  actual  inflamma 
tion,  are  the  symptoms  which  especially  mark  the 
complaint. 

For  the  symptoms  of  neuralgia  affecting  internal 
organs,  we  refer  our  readers  to  the  articles  upon  gas- 
trodinia  and  angina  pectoris. 

Causes.  —  Pathological  researches  have  as  yet 
thrown  but  little  light  upon  the  nature  of  neuralgia. 
Many  excellent  observers  have  instituted  rigid  autop- 
sical  examinations,  in  order  to  ascertain  its  precise 
nature  and  location,  but  their  labours  for  the  most 
part  have  proved  fruitless  ;  since  no  lesions  or  other 
marks  of  diseased  action  have  been  discovered,  either 
in  the  nerves  or  their  envelopes,  at  all  sufficient  to 
account  for  the  symptoms. 

Dr.  Macculloch  believes  neuralgia  to  be  a  malarious 
disease  ;  this  opinion  is  founded  upon  the  fact  of  its 
frequent  occurrence  in  marshy  districts,  and  in  loca 
tions  where  intermittent  fever  abounds.  It  is  probable, 
however,  in  these  cases,  that  the  miasmatic  influence 
operates  merely  to  excite  or  to  call  into  active  opera 
tion  a  diseased  condition  of  the  nerves,  latent  it  is  true, 
but  already  existing.  The  malaria  operates  in  these 
instances,  as  the  immediate  exciting  cause,  and  in  a 
manner  similar  to  impure  air,  errors  in  diet,  excessive 
mental  or  physical  labour,  abuse  of  narcotics  or  stimu 
lants,  over-excitement,  fatigue,  exhaustion,  great  loss 
of  fluids,  and  the  depressing  emotions.  The  remote 
cause  and  the  real  nature  of  the  disorder  remain  un 
explained.  A  conclusive  fact  in  refutation  of  the  views 
of  McCulloch  respecting  the  malarious  origin  of  the 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      427 

disease,  is  its  common  occurrence  in  New  England, 
where  intermittent  fevers  do  not  prevail. 

Neuralgic  pains  sometimes  arise  from  the  pressure 
of  tumours  and  exostoses,  the  irritation  of  decayed 
and  ulcerated  teeth,  and  also  from  mechanical  inju 
ries.  In  these  instances  we  may  generally  remove  the 
cause  by  surgical  means,  and  thus  cure  the  disorder. 

Therapeutics. — The  specific  medicines  for  the  cure 
of  neuralgia,  are,  arsenicum,  belladonna,  colocynth,  nux 
vomica,  aconite,  china,  arnica,  bryonia,  calcarea  carb., 
hepar  sulph.,  phosphorus,  acid  hydrocianic,  pulsatilla, 
sepia,  sulphur,  spigelia,  stramonium,  mercurius. 

Arsenicum. — External  indications.  —  Temperament, 
leuco-phlegmatic,  lymphatic,  or  bilious  and  choleric, 
or  nervous,  with  disposition  to  melancholy  ;  general 
appearance  of  debility  and  exhaustion  ;  countenance 
pale  and  sunken,  or  bloated  and  red  ;  features  distort 
ed  ;  lips  bluish  ;  twitchings  of  the  muscles  of  the  face, 
lips,  and  eyelids ;  tongue  white ;  coldness  of  the  ex 
tremities  ;  anasarca  ;  emaciation  ;  trembling  of  the 
limbs  ;  cramps  in  the  extremities  ;  pulse  small. 

Physical  sensations. — Paroxysms  of  excruciating 
pain  in  the  head,  particularly  in  the  forehead  over  the 
root  of  the  nose, — over  the  left  eye, — in  one  side  of  the 
head, — in  one  eye  :  pains  aggravated  from  the  slight 
est  movement  or  touch ;  scalp  sensitive  to  touch  or 
to  motion  of  the  hair ;  roaring  in  the  ears  during  the 
pain  ;  mouth  dry  ;  thirst  or  adypsia ;  bad  taste  in  the 
mouth  ;  aversion  to  food  ;  nausea,  eructations,  hic 
cough  ;  pressure,  heat  or  burning,  or  cramplike  sen 
sations  in  the  stomach  ;  drawings  and  cramps  in  the 
arms  and  legs  ;  cramps  in  the  fingers  ;  rigidity  of  the 
hands  ;  violent  lancinating  pains  in  different  parts  of 
the  body,  aggravated  by  movement  or  touch,  attended 
with  paralytic  weakness,  contractive  sensations,  faint- 
ness,  coldness,  shuddering  and  trembling. 

Mental  and  moral  symptoms. — Fits  of  violent  an 
guish  ;  fear  ;  dread,  with  tremours  ;  impaired  memory  ; 
inability  to  think  or  collect  the  thoughts  ;  dizziness  ; 
vertigo  ;  general  uneasiness. 

Administration. — A  dose  of  the  second  or  third  tri- 
turation,  every  half  hour  until  an  aggravation  or  ame 
lioration  of  the  symptoms  occurs. 


428      DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM. 

Belladonna. — This  medicine  is  well  adapted  to  the 
'*  diseases  of  women  and  children,  whose  nervous  sys 
tems  are  in  a  state  of  erethism."  The  external  indi 
cations  are,  sanguine  and  choleric  temperament ;  gen 
eral  appearance  indicative  of  a  full  and  plethoric 
habit ;  cheeks  red  and  swollen  ;  eyelids  spasmodically 
closed  :  spasms  and  startings  in  different  parts  of  the 
body  ;  distortion  of  the  face  ;  trembling  and  rigidity 
of  the  limbs. 

Physical  sensations. — Great  sensitiveness  to  cold  air 
and  light  ;  headache,  compelling  to  close  the  eyes ; 
acute  throbbing  pains  in  the  forehead  ;  semi-lateral 
headache  ;  pains  aggravated  by  movement,  noise, 
light  or  cold  air ;  lancinating  pains  in  the  orbit ;  spasms 
of  the  eyes  ;  violent  stitches  in  the  parotid  gland,  ex 
tending  to  the  external  and  internal  ear  ;  roaring  in 
the  ears  ;  paroxysms  of  tearing,  digging  toothache  ; 
toothache  of  pregnant  females  ;  neuralgic  pains  dart 
ing  from  the  side  of  the  face  to  the  teeth  and  ears,  of 
a  tearing,  or  lancinating,  or  digging  character,  with 
heat  and  redness  of  the  part  affected  ;  toothache  oc 
curring  after  eating,  from  contact  with  cold  air,  from 
study,  from  pressure  upon  a  decayed  tooth,  from  eat 
ing,  and  from  swelling  and  ulceration  of  the  gums  ; 
darting  pains  in  the  lower  jaw,  and  in  the  glands  of 
the  affected  parts,  from  a  decayed  and  hollow  tooth ; 
toothache  with  drawing  in  the  ear  ;  neuralgia  affect 
ing  the  crural  nerve  ;  cutting,  darting,  and  tearing  in 
the  left  thigh  when  sitting  ;  lancinating  pains  in  the 
right  thigh  when  sitting  ;  tearing  and  lancinating 
pains  in  the  region  of  the  tibia,  extending  to  the  calf 
of  the  leg  and  sole  of  the  foot  ;  neuralgic  pains  in  the 
back  and  shoulders. 

Mental  and  moral  symptoms. — Anguish  ;  desponden 
cy  ;  great  irritability ;  vertigo  ;  confusion  of  ideas ; 
delirium;  inclination  for  firm  pressure  upon  the  head, 
which  affords  relief,  while  slight  touches  increase  the 
pains. 

Administration. — A  drop  of  the  second  or  third  di 
lution  on  sugar  or  in  water  every  half  hour,  until  a 
decided  impression  is  produced. 

Colocynth. — Dr.  Watzke  remarks  as  follows  respect 
ing  the  therapeutic  action  of  colocynth  in  neuralgic  af- 


DISEASES    OF    THE    BRAIN    AND    NERVOUS    SYSTEM.      429 

fections  : — "  The  curative  sphere  of  action  of  colocynth 
in  the  new  system,  is  almost  confined  to  a  few  neural 
gia  and  hypercesthenice,  and  of  these,  almost  exclusive 
ly  those  which  affect  the  trigeminus,  the  caliac  plexus, 
and  the  lumbar  and  femoral  nerves.  First :  the  he- 
micrania  and  prosopalgise  which  colocynth  cures,  pro 
ceed  from  an  exaltation  of  sensibility  dependent  on 
rheumatic,  gouty,  or  gastric  irritation,  or  on  conges 
tion  of  the  fifth  pair  of  nerves,  in  all  cases  on  a  purely 
functional  affection  of  the  sensitive  filaments.  Colo 
cynth  is  of  no  use  in  organic  prosopalgiae,  from  grow 
ing  out  of  the  teeth,  hypertrophy  of  the  bones  of  the 
skull  or  face,  tumours,  &c. 

"  Second  :  the  neuralgia  of  the  co3liac  plexus  and 
its  branches,  are  particularly  likely  to  be  quickly  and 
permanently  removed  by  colocynth  when  they  occur 
as  substantive  affections,  not  caused  by  derangements 
of  the  stomach,  but  by  cold,  vexation,  or  anger,  occur 
ring  during  the  period  of  evolution  ;  complicated  with 
spinal  irritation  and  neuralgia  of  the  great  nerves  of 
the  thigh,  with  haemorrhoids,  chronic  diarrhoea,  or  ver 
micular  symptoms." 

Colocynth  is  adapted  to  dry,  bilious  and  choleric- 
melancholy  temperaments.  It  is  especially  suitable 
in  cases  of  neuralgia,  confined  to  certain  parts  of  the 
left  side  of  the  body.  The  paroxysms  are  usually  at 
tended  with  spasms,  twitchings,  and  contractive  sen 
sations  ;  and  the  lancinations  are  sudden,  violent,  and 
extend  to  a  distance  from  the  starting  point. 

Administration. — A  drop  of  the  third  dilution  in  wa 
ter,  every  hour,  until  its  effects  are  apparent. 

Nux  Vomica. — External  indications. — Temperament 
sanguine  or  choleric ;  disposition  lively,  artful  and 
malicious  ;  face  pale  or  highly  coloured  ;  contractions 
of  the  hands  and  feet ;  coldness  of  the  body,  especially 
after  drinking ;  trembling  of  the  limbs  ;  fainting  fits, 
spasmodic  twitchings  in  different  parts  of  the  body  ; 
better  adapted  to  males  than  females. 

Physical  sensations. — Periodical  and  intermittent 
pains ;  excessive  sensibility  of  the  affected  parts  to 
external  impressions  of  all  kinds  ;  periodical  head 
ache  every  morning  after  rising,  increasing  until  noon, 
then  gradually  diminishing  until  night,  when  the  pain 


430   DISEASES  OF  THE  BRAIN  AND  NERVOUS  SYSTEM. 

ceases  \  the  pains  are  drawing,  tearing,  compressive, 
affecting  the  whole  head,  or  the  forehead,  or  the  part 
just  above  the  root  of  the  nose ;  headache  accompa 
nied  with  confusion  of  ideas,  nausea,  bitter  eructa 
tions,  vomitings,  constipation  ;  scalp  painful  and  sensi 
tive  to  touch  or  cold  air  ;  tearing  pains  in  the  facial 
and  infra  orbital  nerves ;  ringing  in  the  ears ;  tooth 
ache  in  sound  and  decayed  teeth  ;  pains  of  a  sticking, 
drawing,  tearing,  jerking,  or  digging  character,  aggra 
vated  by  cold  air  and  drinks,  by  study  and  meditation, 
and  relieved  by  rest  and  warmth ;  toothache  from 
cold,  and  from  extraction  of  a  tooth  ;  drawing  tooth 
ache  in  several  teeth  ;  looseness  of  the  teeth  ;  swelling 
of  the  gums  ;  drawing  toothache  in  a  hollow  tooth, 
with  pains  extending  to  the  face  and  temples  ;  gastro- 
dynia  attended  with  violent,  cramp-like,  contractive 
and  tearing  pains  in  the  stomach  ;  pleurodinia ;  con 
tractions  and  cramps  in  the  hands,  feet  and  limbs  ; 
coldness  of  the  hands  and  feet ;  painful  contractive 
sensations  throughout  the  body ;  faintness ;  languor, 
and  indisposition  to  mental  or  physical  exertion. 

Mental  and  moral  symptoms. — Great  sensitiveness  to 
external  impressions  ;  melancholy  ;  sadness  ;  appre 
hension  ;  anxiety  ;  petulancy  ;  indisposition  to  mental 
exertion. 

Administration. — This  medicine  may  be  employed 
in  the  same  manner  as  Belladonna. 

We  have  occasionally  employed  Aconite  with  ad 
vantage  in  neuralgia,  accompanied  with  great  ere 
thism  of  the  vascular  system,  flushes  of  heat,  conges 
tion  of  the  head,  chest,  and  heart.  Whenever  the 
function  of  the  heart  appears  to  be  affected  in  neural 
gia,  this  remedy  will  generally  prove  useful. 

When  neuralgia  has  arisen  from  excessive  loss  of 
the  fluids  of  the  body,  we  may  refer  to  china,  phosphor  us, 
calcarea  carb.,  and  sepia. 

When  the  disease  appears  to  be  connected  with 
scrofula,  exostoses  of  the  bones,  chronic  cutaneous  af 
fections,  abuse  of  mercury,  constitutional  syphilis, 
glandular  and  other  tumours,  reference  should  be 
made  to  sulphur,  mercurius,  hepar  sulph.,  sepia  and 
aurum  muriaticum. 

In  neuralgic  attacks  of  the  heart,  or  stomach,  or 


DISEASES    OF   THE    BRAIN    AND    NERVOUS    SYSTEM.     431 

uterus,  our  best  remedies  are  nux  vomica,  acid  hydro 
cyanic,  pulsatilla  and  colocynth. 

Neuralgia  from  mechanical  injuries,  will  commonly 
yield  to  arnica,  aconite  and  calendula. 

For  a  more  particular  description  of  the  neuralgic 
symptoms  pertaining  to  special  organs,  and  the  mode 
of  treatment,  we  refer  to.  the  diseases  of  the  different 
organs  and  tissues  in  other  parts  of  this  work. 

Administration. — A  wide  range  of  attenuations 
should  be  employed  in  neuralgia,  in  order  that  we  may 
adapt  our  remedies  precisely  to  the  degree  of  erethism 
present  in  each  particular  case.  When  the  pains  are 
very  acute,  the  dose  may  be  repeated  every  hour  until 
relief  is  obtained,  or  until  a  medicinal  aggravation 
admonishes  us  to  discontinue  the  medicine. 


432 


CHAPTER  XXVI. 

DISEASES  OF  THE  URINARY  AND  GENITAL  ORGANS. 
SECTION  I. 

NEPHRITIS. INFLAMMATION  OF  THE  KIDNEYS. 

Diagnosis. — Inflammation  of  the  kidneys  commen 
ces  with  the  ordinary  febrile  symptoms,  like  slight 
chills,  hot  and  dry  skin,  thirst,  frequent  and  hard  pulse, 
either  accompanied  from  the  first,  or  speedily  succeed 
ed  by  deep-seated,  aching  pain  in  the  region  of  the 
kidneys,  which  soon  becomes  acute  and  pulsative ; 
urine  scanty  and  high-colored  ;  entire  inability  to  lie 
upon  the  healthy  side  or  upon  the  stomach ;  position 
mostly  upon  the  back  when  reclining,  or  on  the  affect 
ed  side,  with  the  dorsal  and  lumbar  muscles  flexed  ; 
inability  to  lie  upon  the  diseased  side  with  the  muscles 
extended ;  severe  pains  upon  rising  up  to  the  erect 
posture,  or  from  the  concussions  arising  from  riding, 
walking,  or  running ;  when  the  disease  is  strongly 
pronounced,  there  are,  absolute  inability  to  walk,  or 
even  to  stand  upon  the  feet;  pressure  over  the  inflam 
ed  kidney  does  not  cause  pain,  but  any  motions  which 
call  into  exercise  the  deep-seated  dorsal  or  lumbar 
muscles,  excite  acute  pain  ;  the  inflammation  gener 
ally  attacks  the  left  kidney;  both  kidneys  are  rarely 
affected  at  the  same  time  in  the  first  instance  ;  the 
pain  at  first  is  aching,  compressive  and  dull,  but  often 
becoming,  in  severe  cases,  violent  and  lancinating  ; 
the  pains  extend  along  the  ureters  to  the  bladder,  or 
follow  the  spermatic  cord  to  the  testicles  ;  the  urine  is 
very  scanty,  bloody,  purulent  or  red,  or  watery ;  con 
stant  desire  to  urinate  ;  there  are  nausea,  eructations, 
vomitings,  flatulence,  constipation :  pains  in  the  rec 
tum,  from  contiguous  sympathy ;  tenesmus ;  swelling 
and  heat  over  the  affected  side  ;  when  complicated 
with  calculi,  there  will  be  retraction  of  the  testicle ; 
numbness  of  the  thigh  ;  anxiety,  and  more  severe  con 
stitutional  disturbance. 


AND    GENITAL    ORGANS.  433 

Nephritis  may  readily  be  distinguished  from  lumba 
go,  inflammation  of  the  psoas  muscle,  and  neuralgia, 
by  the  character  and  direction  of  the  pains  which  fol 
low  the  ureters  to  the  vcsiculce  seminales,  or  the  sper 
matic  cords  to  the  testicles ;  also  by  the  nausea,  vo 
miting,  constant  desire  to  urinate  ;  the  partial,  and  in 
some  cases  almost  entire  suppression  of  the  urinary 
secretion  ;  the  sympathetic  pains  in  the  rectum  ;  and 
the  increase  of  pain  whenever  any  of  the  muscles 
which  bear  upon  the  kidneys  are  extended. 

The  terminations  of  nephritis  are,  resolution,  sup 
puration,  induration,  schirrus,  or  gangrene.  The  dura 
tion  of  the  acute  stage  is  usually  from  six  to  nine  days, 
when  one  of  the  above  terminations  usually  obtains. 

Its  termination  in  resolution  is  indicated  by  a  grad 
ual  return  of  all  the  functions  to  a  more  healthy 
state  ;  increased  secretion  of  urine,  which  deposits  an 
abundant  sediment ;  moderate  and  general  perspira 
tion  ;  subsidence  of  the  pains  ;  ability  to  lay  on  either 
side,  or  to  walk  without  difficulty. 

When  suppuration  has  taken  place,  the  pains  be 
come  less  severe  ;  there  are  chills,  or  shiverings  ;  dull 
throbbing  in  the  region  of  the  kidneys  ;  sometimes  ap 
pearance  of  pus  in  the  urine  ;  a  sensation  of  numbness 
and  weight  in  the  affected  side  ;  a  partial  subsidence 
of  the  febrile  symptoms ;  and  occasionally  an  ab 
scess,  which  may  be  recognised  by  swelling  and  fluc 
tuation  in  the  part. 

The  purulent  matter  may  be  discharged  by  the 
ureters  into  the  bladder,  or  find  its  way  between  the 
lumbar,  or  the  internal  crural  muscles,  to  the  thigh,  or 
it  may  find  its  way  by  ulceration  into  the  cavity  of  the 
spleen,  the  liver,  or  the  colon,  or  it  may  burst  exter 
nally. 

In  these  cases  fistulous  passages  are  apt  to  remain 
for  a  long  period,  giving  issue  to  the  pus  and  urine. 

In  a  very  few  instances,  after  the  acute  symptoms 
have  subsided,  there  remains  a  chronic  induration  of 
the  kidneys,  which  in  the  end  degenerates  into  a  true 
schirrus.  In  other  rare  instances,  when  the  inflamma 
tion  has  been  exceedingly  violent,  and  suitable  remedial 
measures  have  not  been  employed,  the  vitality  of  the 

19 


434  DISEASES    OF    THE    URINARY 

part  becomes  destroyed,  and  gangrene  is  the  result. 
The  occurrence  of  gangrene  is  recognised  by  the  pale, 
sunken,  and  deathlike  expression  of  countenance,  cold, 
clammy  sweats,  universal  prostration,  constant  vomit 
ing,  delirium,  small  and  frequent  pulse,  absence  of 
pain,  hiccough,  and  dark  and  foetid  urine.  Whenever 
either  of  the  last  described  occurrences  take  place,  no 
hopes  of  cure  should  be  entertained. 

Causes. — External  injuries,  strains  from  violent  ex 
ercise  or  lifting  heavy  weights,  the  irritation  of  calculi, 
sudden  check  to  the  perspiration  from  cold,  abuse  of 
medicinal  or  morbid  substances  which  operate  speci 
fically  upon  the  kidneys. 

Therapeutics. — Frequent  external  applications  of 
cold  water  over  the  inflamed  kidney  will  be  of  great 
service  in  abstracting  the  superfluous  animal  heat,  and 
thus  allaying  the  inflammation.  The  water  should  be 
applied  quite  cold,  and  repeated  until  the  temperature 
of  the  part  is  permanently  diminished,  and  the  pain 
has  in  a  measure  subsided. 

The  specific  medicines  are,  cantharides,  cannabis, 
tmsilago  petus.,  aconite,  copaiba?,  terelrinlhina,  bella 
donna,  arnica,  nux  vomica,  and  pulsatilla. 

As  soon  as  we  are  called  to  a  case  of  nephritis,  we 
should  have  immediate  recourse  to  aconite,  either 
alone  or  in  alternation  with  one  of  the  other  specifics, 
and  continue  it  until  the  febrile  symptoms  have  sub 
sided.  In  slight  cases,  aconite  alone  as  an  internal 
remedy,  together  with  thorough  external  applications 
of  cold  water,  will  suffice. 

If  the  inflammation  be  of  a  severe  grade,  and  there 
are  tearing,  drawing,  and  pulsative  pains  in  the  region 
of  the  kidneys,  extending  to  the  bladder  and  testicle, 
constant  desire  to  urinate,  scanty  secretion  of  high- 
coloured  urine,  inability  to  lay  on  the  affected  side, 
tenesmus,  colic-pains,  urine  tinged  with  blood,  painful 
micturition,  aconite  in  alternation  with  the  third  dilu 
tion  of  cantharides,  or  cannabis,  or  terebinth,  or  tussila- 
go  petus.,  or  bals.  copaib.,  may  be  exhibited. 

Arnica  is  suitable  for  inflammation  of  the  kidneys, 
caused  by  external  injuries,  concussions,  sprains  from 
lifting,  &c. 


AND  GENITAL  ORGANS.  435 

When  there  is  reason  to  suspect  that  suppuration  is 
about  commencing,  sulphur,  sepia,  and  hjcopodium,  may 
be  used  with  advantage. 

SECTION  II. 

CYSTITIS. INFLAMMATION  OF    THE    BLADDER. 

Diagnosis. — Inflammation  of  the  bladder  commences 
like  nephritis,  with  shiverings  or  chills,  frequent  pulse, 
hot  and  dry  skin,  anxiety,  thirst,  urine  scanty  and 
high-coloured,  nausea,  vomiting,  eructations,  and  con 
stipation.  In  a  short  time,  the  patient  experiences 
deep-seated  lancinating  pains  in  the  hypogastric  re 
gion,  frequent  desire  to  urinate,  each  effort  giving  rise 
to  increased  pain,  great  anxiety,  and  uneasiness.  As 
the  inflammation  extends,  the  pains  become  more  se 
vere,  and  there  are  a  continual  burning  sensation  in  the 
bladder,  with  painful  pulsations ;  acute  pain  on  mak 
ing  pressure  in  the  vicinity  of  the  inflammation,  and 
when  attempting  to  urinate  ;  sense  of  weight  in  the 
hypogastric  region ;  acute  or  dragging  pains  in  the 
loins,  the  ureters,  the  perineum,  and  the  anus ;  swel 
ling  and  distention  of  the  abdomen  ;  great  difficulty  in 
voiding  the  faeces,  on  account  of  the  sympathetic  in 
flammation  of  the  rectum  ;  all  movements  of  the  mus 
cles  which  bear  upon  the  bladder  excite  increased 
pains;  and  finally  rigours,  cadaverous  expression,  cold 
extremities,  delirium  and  convulsions.  If  the  inflam 
mation  be  confined  to  the  neck  of  the  bladder,  there 
will  be  an  almost  entire  suppression  of  the  urinary 
discharge  ;  constant  ineffectual  and  exceedingly  pain 
ful  efforts  to  urinate  ;  and  violent  pain  in  the  perineum. 
If  the  ureters  become  involved,  pains  are  frequently 
felt  as  high  as  the  kidneys ;  the  secretion  of  urine 
becomes  more  deranged,  the  suppression  is  more  de 
cided,  and  the  attempts  tb  void  the  urine  still  more 
painful.  When  the  \vhole  interior  surface  of  the  blad 
der  is  affected,  the  urine  is  red  and  tinged  with  blood, 
and  a  severe  burning  and  throbbing  pain  is  experi 
enced.  Occasionally  the  external  surface  of  the  organ 
becomes  inflamed,  either  on  one  side,  on  its  anterior 
or  posterior,  or  its  superior  or  inferior  part ;  in  which 


436  DISEASES    OF    THE    URINARY 

cases  the  symptoms  will  be  in  correspondence  with  the 
location  of  the  malady. 

Cystitis  may  terminate  in  chronic  inflammation  of 
the  bladder,  in  resolution,  suppuration,  or  gangrene. 

The  signs  which  indicate  these  different  termina 
tions,  are  similar  to  those  described  under  nephritis. 

Causes. — Injuries  resulting  from  child-birth,  from 
the  use  of  instruments  during  accouchement,  from 
blows,  concussions  and  falls,  from  gravel,  stone,  abuse 
of  diuretics,  metastases  of  erysipelas,  rheumatism,  or 
gonorrhoea,  the  use  of  stimulating  injections  into  the 
urethra,  prolonged  retention  of  urine,  introduction  of 
catheters  and  sounds  into  the  bladder,  suppression  of 
the  menses,  and  extension  of  inflammation  from  neigh 
bouring  parts. 

Therapeutics. — Aconite,  cantharides,  cannabis,  thuya 
occiden,  terebinthina,  copaibce,  tussilago  petus.,  and 
asparagus,  are  our  best  specifics.  They  may  be  em 
ployed  at  the  first,  second  and  third  attenuations, 
either  alone  or  in  alternation  with  aconite,  and  the 
doses  repeated  as  the  urgency  of  the  symptoms  shall 
require. 

SECTION  III. 

DIABETES. 

Numerous  hypotheses  have  been  offered  respecting 
the  seat  and  nature  of  this  singular  malady,  but 
neither  of  them  appears  to  afford  a  satisfactory  expla 
nation  of  all  its  phenomena.  The  affection  has  been 
referred  to  a  morbid  condition  of  the  kidneys  alone, 
also  to  derangement  of  the  stomach,  of  the  liver,  to 
a  defect  in  the  fluids,  to  suppressed  perspiration,  to 
an  imperfect  animalization  of  the  blood,  to  the  re 
trograde  action  of  the  lymphatics,  and  to  an  unnatural 
waste  of  the  body,  thus  calling  into  increased  activity 
the  digestive  and  assimilative  functions  to  supply  the 
waste.  Galen,  who  saw  but  two  cases  of  diabetes 
during  his  life,  supposed  that  it  was  caused  by  an 
inflammation  of  the  kidneys,  "  which  made  them  draw 
much  serum  from  the  emulgents."  Aretseus  attributed 
it  to  a  feeble  and  relaxed  condition  of  the  kidneys, 
"  which  weakens  the  retentive  faculty."  Actius  be- 


AND    GENITAL    ORGANS.  437 

lieved  that  the  cause  consisted  in  "  an  afflux  of  sharp 
or  salt  humours,  which  continually  stimulated  the 
veins  to  expulsion."  Van  Helmont  attributed  it  to  a 
paralysis  of  the  muscles  of  the  bladder.  Willis,  who 
first  pointed  out  the  saccharine  character  of  the  urine, 
thought  it  was  caused  by  "  the  dissolution  and  over- 
lax  frame  of  the  blood,  whereby  it  loses  its  serum 
before  it  has  done  its  office."  Sylvius  says :  "  the 
disease  arises  from  a  sharp  volatile  salt,  either  re 
ceived  from  without,  or  inbred  in  the  parts."  Cullen, 
Sydenham,  Rollo,  and  Home,  regarded  the  affection 
as  '*  dependent  primarily  on  a  disordered  state  of  the 
digestive  organs,  in  conjunction  with  a  defect  in  the 
assimilating  functions." 

This  last  opinion  is  probably  the  correct  one,  and 
much  credit  is  due  to  Bouchardat  for  having  first 
pointed  out  the  changes  which  certain  aliments  un 
dergo  in  consequence  of  this  disordered  state  of  the 
digestive  apparatus.  Dr.  B.  broached  the  opinion, 
that  "  in  diabetes,  starch  was  converted  in  the  intes 
tines  into  sugar,  which  passed  into  the  blood  and 
urine."  Hence,  a  diet  composed  chiefly  of  neutral 
azotised  substances,  to  the  exclusion  of  starch,  has 
been  recommended  for  the  cure  of  this  disease,  and, 
in  some  instances,  with  success. 

It  may,  then,  be  safely  assumed,  that  the  primary 
cause  of  diabetes  consists,  first,  in  a  morbid  state  of 
the  digestive  and  assimilative  organs,  which  favours 
the  formation  of  dextrine,  or  sugar,  from  the  starchy 
or  farinaceous  substances  introduced  into  the  alimen 
tary  canal,  and  its  absorption  into  the  blood  and  urine. 
The  following  are  a  few  of  the  reasons  for  this 
opinion  :  Diabetes  is  usually  attended  from  the  first, 
with  a  disordered  state  of  the  digestive  organs,  as  is 
indicated  by  uneasy  sensations  in  the  stomach  after 
eating,  impaired  or  morbidly  increased  appetite,  eruc 
tations,  nausea,  vomiting,  bad  taste,  and  dryness  of  the 
mouth  and  tongue. 

The  function  of  the  stomach  is  exceedingly  com 
plicated,  and  is  inflamed,  perhaps,  more  than  any 
other  organ  of  the  body,  by  the  numerous  natural  or 
artificial  circumstances  which  constantly  operate 
upon  living  beings.  When  the  organism  is  in  a  sound 


438  DISEASES    OF    THE    URINARY 

condition,  and  no  disturbing  causes  exercise  an  in 
fluence,  the  digestive  apparatus  elaborates  thoroughly 
a  certain  amount  of  chyle,  and  the  assimilative  organs 
take  it  up  and  appropriate  it  in  a  certain  manner. 
But  these  functions  may  be  impaired,  suspended,  or 
even  unduly  increased,  by  moral  and  physical  causes. 
Ill  news,  grief,  chagrin,  mortification,  disappointment, 
anger,  fear,  dread,  apprehension,  and  disagreeable 
sights,  often  suspend  both  digestion  and  assimilation. 
These  functions  may  also  be  impaired  or  suspended 
from  the  abuse  of  drugs,  stimulants,  tobacco,  coffee, 
tea,  sedentary  habits,  excessive  bodily  fatigue,  want 
of  sleep,  the  irritation  of  vitiated  bile,  or  of  the  gas 
tric  fluid,  or  of  acids,  excesses  in  eating,  or  the  use  of 
indigestible  food,  inflammation,  &c.  They  may  also 
be  morbidly  increased  by  tonics  and  stimulants,  like 
bark,  the  preparations  of  iron,  the  bitter  infusions, 
wine,  alcoholic  liquors,  cordials,  and  condiments. 

In  the  malady  under  consideration,  the  digestive 
organs  are  in  a  peculiar  condition.  The  thirst  is  in 
tense,  and  the  appetite  voracious,  yet  the  digestive 
function  is  perverted,  the  aliments  are  imperfectly 
converted  into  chyle,  a  superabundance  of  saccharine 
matter  is  elaborated,  while  the  activity  of  the  absorb 
ents  is  astonishingly  increased. 

That  farinaceous  aliments  are  really  converted  into 
sugar  in  the  stomachs  of  diabetic  patients,  is  evident 
from  the  fact  that  traces  of  it  have  been  detected  in 
the  matters  ejected  by  them  after  the  use  of  farina 
ceous  food.  It  is  also  proved  from  the  circumstance, 
that  when  this  kind  of  food  is  withheld,  both  the  se 
cretion  of  urine  and  its  saccharine  character  is  mate 
rially  diminished. 

Matteucci  has  demonstrated,  that  "  starchy  sub 
stances,  when  introduced  into  the  stomach  and  intes 
tines  of  diabetic  patients,  are  converted  into  dextrine, 
or  sugar,  by  the  saliva,  or  pancreatic  juice,  and  are 
then  absorbed  directly  into  the  blood,  either  in  this 
form,  or  after  having  been  converted  into  lactic  acid." 

The  experiments  of  Dutrochet,  Cuna,  and  Mat 
teucci  have  proved  that  different  liquids  may  pass 
through  the  stomach,  membranes,  skin,  and  other  ani 
mal  tissues,  by  absorption,  imbibition,  endosmose,  or 


AND    GENITAL    ORGANS.  439 

exosmos*,  the  activity  and  direction  of  these  pheno 
mena  depending  upon  the  character  and  position  of 
the  fluid  used,  and  the  physiological  condition  of  the 
structure  acted  on.  Thus,  "  azotised  neutral  sub 
stances  dissolved  in  the  stomach  by  the  acid  liquid, 
or  by  the  catalytic  action  of  pepsine,  pass  into  the 
blood  merely  by  the  imbibition  of  the  coats  of  the 
capillary  bloodvessels  of  the  stomach."  Water,  and 
alcoholic  drinks,  introduced  into  the  stomach,  are  also 
absorbed  ;  they  do  not  pass  beyond  this  viscus,  nor 
are  they  to  be  found  in  the  chyle,  yet  they  reach  the 
blood." 

In  diabetes,  the  digestive  organs  appear  to  have 
lost  the  power  to  elaborate  healthy  chyle,  and  also 
the  absorbents  of  resisting  the  entrance  of  the  sac 
charine  fluids  formed  by  this  perverted  action. 
Whether  the  nature  of  this  morbid  condition  is  of  an 
inflammatory  or  non-inflammatory  character,  whether 
dependent  upon  exalted  action  or  laxity,  loss  of  tone 
or  paralysis  of  the  affected  parts,  is  somewhat  prob 
lematical,  although  we  incline  to  the  opinion,  that  the 
disease  is  essentially  dependent  upon  a  relaxed  and 
enfeebled  condition  of  the  digestive  and  assimilative 
functions. 

But  an  objection  will  be  urged  to  the  above  views, 
because  the  quantity  of  sugar  found  in  the  urine  of 
diabetic  persons  is  not  at  all  proportionate  to  that  of 
the  fecula  taken  as  aliment ;  but  this  argument  falls 
to  the  ground  when  we  reflect  that  the  uric  acid  and 
the  urea  derived  from  the  rapid  metamorphosis  of  the 
tissues,  is  likewise  converted  into  sugar,  and  passes, 
with  the  fluids  arising  from  these  changes,  through 
the  blood  and  kidneys,  thus  contributing  to  make  up 
the  enormous  quantity  of  saccharine  fluid  which  is 
observed  in  this  affection.  Prout  has  shown  that  the 
constituent  elements  of  urea  and  sugar  are  the  same, 
and  exist  in  similar  proportions  ;  from  which  fact,  we 
can  readily  comprehend  the  change  from  one  sub 
stance  to  the  other,  and  the  affinity  exercised  by  the 
saccharine  fluid  circulating  in  the  blood,  upon  the 
urea  arising  from  the  transformation  of  the  tissues. 

Second.  As  a  consequence  of  this  primary  derange 
ment  of  the  digestive  and  assimilative  functions,  the 


440  DISEASES    OF    THE   URINARY 

saccharine  fluids  formed,  are  transmitted  rapidly 
through  the  blood,  absorbing,  during  their  course,  the 
changed  urea,  and,  finally,  eliminated  by  the  kidneys. 
It  is  the  office  of  the  kidneys  to  separate  from  the  or 
ganism  all  substances  incapable  of  further  use, 
whether  such  useless  substances  are  the  product  of 
the  natural  secretions,  or  of  the  transformations  of 
the  tissues.  Now,  as  sugar  is  a  substance  foreign 
and  injurious  to  the  blood,  it  is  taken  up  as  fast  as 
formed,  and  conveyed  speedily  to  the  kidneys,  which 
separate  it,  after  which  it  passes  off  through  the  blad 
der.  This  is  evident  from  the  fact,  that  when  a  solu 
tion  of  sugar  is  injected  into  the  veins  of  an  animal, 
it  does  not  remain  in  the  blood,  but  makes  its  appear 
ance  very  speedily  in  the  urine.  It  is  on  this  account 
that  it  is  so  difficult  to  detect  sugar  in  the  blood  of 
diabetic  patients,  although  traces  of  it  have  been  found 
by  Dr.  Capezzuoli,  not  only  in  the  blood,  but  in  the 
contents  of  an  abscess  of  a  diabetic  patient. 

When  more  saccharine  matter  is  absorbed  than  can 
be  speedily  eliminated  by  the  kidneys,  it  is  highly 
probable  that  it  passes  off  through  the  liver,  the  sali 
vary  glands,  the  pancreas,  and  even  into  abscesses, 
rather  than  remain  in  the  mass  of  the  blood. 

Third.  The  kidneys  themselves  being  constantly 
acted  upon  by  a  fluid  unlike  their  natural  stimuli,  be 
come  irritated,  their  vessels  enlarged,  and  thus  excited 
into  unnatural  activity.  This  fluid  also  often  gives  rise 
to  an  inflammation  about  the  orifice  of  the  urethra. 

Diagnosis. — In  tracing  the  progress  of  diabetes,  and 
noting  carefully  the  symptoms  which  are  especially 
characteristic,  it  will  be  found  that  a  very  intimate 
connection  necessarily  exists  between  these  symptoms 
and  the  pathological  conditions  above  described. 

In  the  first  instance,  there  are  indications  of  de 
rangement  of  the  digestive  apparatus,  as  morbid  ap 
petite,  distress  in  the  stomach  after  eating,  flatulent 
distention,  acidity,  eructations,  nausea,  heartburn, 
lassitude,  and  debility. 

When  the  disease  is  fully  formed,  the  prominent 
symptoms  are,  urgent  and  insatiable  thirst,  voracious 
appetite,  hot  and  harsh  skin,  and  the  elimination  of  an 
unusually  large  quantity  of  urine  abounding  in  sac 
charine  matter. 


AND  GENITAL  ORGANS.  441 

As  the  disease  advances,  the  tongue  is  clammy  and 
white,  or  clean  and  red  ;  there  is  distress  after  eating  ; 
a  peculiar  hay-like  odour  issues  from  the  body  and 
lungs  ;  there  are  pain  and  weakness,  and  sometimes 
swelling,  in  the  loins  ;  anxiety  ;  peevishness  ;  despon 
dency  ;  impaired  memory  ;  vertigo  ;  constipation  ;  in 
flammation  about  the  glans  penis  and  the  orifice  of 
the  urethra ;  rapid  and  great  emaciation ;  loss  of 
strength ;  impotence  ;  coldness  of  the  extremities ; 
difficulty  of  breathing  ;  dropsical  effusions  ;  weak  and 
frequent  pulse  ;  great  prostration  of  all  the  powers. 

Diabetic  urine  is  of  a  straw  colour,  of  a  disagreea 
ble  odour,  and  a  sweetish  taste.  The  quantity  voided 
in  different  cases  varies  very  much,  some  patients 
voiding  as  much  as  fifty  or  even  one  hundred  pounds 
in  twenty-four  hours,  while  others  pass  only  eight  or 
ten  pounds  during  the  same  period.  The  average 
quantity  voided  in  twenty-four  hours  may  safely  be 
placed  at  about  fifteen  pounds. 

Diabetes  usually  continues  for  months,  and  some 
times  for  years,  before  it  terminates  fatally.  Hitherto 
it  has  been  almost  invariably  fatal ;  but  may  we  not 
hope  that  the  discoveries  which  have  been  recently 
made,  and  which  are  still  being  made,  in  organic 
chemistry,  as  well  as  in  the  practice  of  medicine,  will 
enable  us  yet  to  understand  and  conquer  this  singular 
and  intractable  malady? 

Therapeutics. — If  the  theory  which  we  have  ad 
vanced  respecting  the  nature  of  diabetes  is  correct,  it 
follows  as  a  consequence,  that  one  of  our  most  im 
portant  therapeutical  indications  consists  in  pointing 
out  a  proper  system  of  dietetics.  We  have  seen  that 
through  a  perverted  action  of  the  digestive  apparatus, 
all  the  farinaceous  or  starchy  substances  consumed 
become  converted  into  sugar,  and  thus  afford  material 
for  the  perpetuation  of  the  malady.  A  rigid  absti 
nence  from  everything  of  a  feculent  nature  should 
therefore  be  insisted  on,  while,  at  the  same  time,  a 
diet  as  nutritious  as  possible  should  be  enjoined,  con 
sisting  of  beef,  mutton,  venison,  fowls,  game,  fish, 
animal  soups,  jellies,  and  articles  of  this  nature.  We 
commend  most  strongly  as  valuable  auxiliary  means 
in  this  affection,  sea  voyages,  and  frequent  applica- 

19* 


442  DISEASES    OF    THE    URINARY 

tions  to  the  whole  surface  of  the  body,  of  salt  water. 
The  free  use  of  ice,  gradually  dissolved  in  the  mouth, 
will  also  prove  serviceable  in  allaying  the  intense 
thirst  which  consumes  the  patient. 

The  internal  remedies  which  have  been  found  most 
successful  in  this  disease  are,  acid  phosphoric,  carbo 
vegetabilis,  nux  vomica,  acid  muriatic,  baryta  muriate, 
belladonna,  uva  ursa,  rhus  rad.,  conium  mac.,  digitalis, 
and  opium. 

Our  experience  has  been  so  limited  in  the  homeo 
pathic  treatment  of  diabetes,  that  we  shall  refrain 
from  extending  our  observations  respecting  the  espe 
cial  indications  and  the  practical  employment  of  each 
particular  remedy,  but  refer  our  readers  to  the 
provings,  and  mode  of  employment,  by  different  medi 
cal  men,  for  further  information  and  suggestion  upon 
the  subject. 

SECTION  IV. 

ENURESIS. INCONTINENCE    OF    URINE. 

Diagnosis. — This  affection  may  be  recognised  by  a 
partial  or  total  loss  of  power  to  retain  in  the  bladder 
the  secreted  urine.  When  the  loss  of  voluntary  power 
over  the  muscles  concerned  is  total,  the  mine  contin 
ues  to  dribble  away  as  fast  as  secreted,  becoming  thus 
an  incessant  source  of  trouble  and  annoyance. 

If  the  loss  of  power  be  only  partial,  the  urine  can 
be  retained  until  a  given  amount  is  accumulated, 
when  the  patient  is  suddenly  compelled  to  yield  to  the 
pressing  demand,  sans  ceremonie.  In  other  instances, 
the  incontinence  is  troublesome  only  during  sleep,  and 
appears  to  be  excited  by  dreams,  constrained  posi 
tions,  &c. 

The  malady  is  unaccompanied  by  febrile  symptoms 
or  pains,  and  usually  occurs  as  a  symptom  of  some 
other  disease. 

Causes. — Complete  enuresis  may  be  caused  by  pa 
ralysis  of  the  sphincter  of  the  bladder  from  constitu 
tional  causes,  from  external  injuries,  from  tedious  and 
protracted  labours,  from  the  pressure  of  tumours,  from 
calculous  deposits,  and  from  abuse  of  diuretics. 

Partial  enuresis  is   a  common   complaint  amongst 


AND    GENITAL    ORGANS.  443 

children,  and  is  particularly  troublesome  in  the  night 
during  sleep.  It  has  too  often  been  attributed  to 
habit,  and  negligence  of  proper  efforts  to  restrain  the 
discharge  on  the  part  of  children,  and  for  this  reason, 
external  applications,  in  the  form  of  "  spanking,"  and 
"  essence  of  birch,"  have  been  employed,  but  so  far  as 
our  knowledge  extends,  without  advantage.  The 
disease  in  these  cases  is  undoubtedly  associated  with 
irritation  at  the  neck  of  the  bladder,  originated  by 
acrid  urine,  gravel,  the  irritation  of  worms  in  the  rec 
tum,  etc. 

Therapeutics. — Cantharides,  cannabis,  uva  ursa,  nux 
vomica,  cicuta  vir.,  sulphur,  calcarea  carb.,  pulsatilla, 
and  rhus,  are  the  chief  remedies. 

For  the  cure  of  paralytic  enuresis,  recourse  should 
be  had  to  cantharides,  nux  vom.,  rhus  and  uva  ursa. 

When  the  disease  occurs  in  children,  our  best  reme 
dies  are,  cantharides,  calcarea  carb.,  and  sulphur. 
When  from  external  injuries,  difficult  accouchements, 
or  the  irritation  of  calculi,  we  may  prescribe  arnica, 
pulsatilla,  rhus,  and  cicuta  virosa. 

Administration. — The  remedies  should  be  used  at 
the  first  or  second  attenuations,  and  a  dose  given  once 
or  twice  daily  as  long  as  necessary. 

SECTION  V. 

SUPPRESSION    AND    RETENTION    OF    URINE. 

The  causes  capable  of  giving  rise  to  suppression  or 
retention  of  urine  are  so  various  and  diversified,  and 
the  circumstances  attending  the  course  and  progress 
of  different  cases  so  numerous,  that  our  description 
must  necessarily  be  confined  to  the  more  prominent 
symptoms  and  occurrences  connected  with  the  malady. 

By  the  term  retention  of  urine,  we  mean  to  include 
all  of  those  cases  in  which  the  urine  is  secreted  by  the 
kidneys  as  usual,  but  where  the  power  to  evacuate  the 
bladder  is  lost ;  while  suppression  of  urine  corresponds 
with  the  affection  known  as  ischuria  renalis,  in  which 
the  secreting  function  of  the  kidneys  is  either  partially 
or  totally  destroyed. 

Ischuria  renalis  is  always  attended  with  danger, 
from  the  peculiar  tendency  which  exists  in  the  brain 


444  DISEASES    OF    THE    URINARY 

to  take  on  diseased  action.  When  there  is  an  entire 
suppression  of  the  urinary  secretion,  from  paraly 
sis  of  the  kidneys,  coma  and  effusion  upon  the  brain 
occur  very  speedily.  In  cases  of  this  description,  the 
saliva,  the  sweat,  the  pulmonary  exhalations,  the  bile, 
the  pancreatic  and  gastric  fluids,  become  impregnated 
with  a  fluid  possessing  the  appearance,  taste  and 
odour  of  urine.  It  has  also  been  observed,  that  the 
liquid  effused  upon  the  brain,  possesses  a  decidedly 
urinous  smell.  In  cases  of  the  disease  dependent  on 
inflammation  of  the  kidneys,  we  shall  have  febrile 
symptoms,  hot  and  dry  skin,  thirst,  nausea,  vomiting, 
rapid  pulse,  tenderness  of  the  abdomen  on  pressure, 
swelling  and  pain  in  the  region  of  the  kidneys,  fre 
quent  desire  to  urinate,  and  the  passage  of  the  small 
quantity  secreted,  causing  great  pain,  urinous  taste  in 
the  mouth,  urinous  odour  of  the  sweat,  anxiety  and 
general  uneasiness.  If  the  suppression  be  total,  the 
symptoms  will  be  still  more  grave,  and  there  will  be 
early  indications  of  serious  cerebral  disorder,  in  the 
form  of  delirium,  rapidly  succeeded  by  coma  and 
effusion. 

On  the  other  hand,  in  suppression,  depending  upon 
paralysis  of  the  kidneys,  the  febrile  symptoms  may  be 
very  slight,  and  there  may  be  an  entire  absence  of 
pain  and  uneasiness  in  the  region  of  the  kidneys  or  in 
the  abdomen,  and  no  desire  to  urinate.  In  these 
instances,  the  danger  is  no  less  imminent  than  in  the 
other  variety,  for  fatal  oppression  of  the  brain  almost 
invariably  ensues,  if  the  malady  persists  more  than 
two  days.  Cases,  however,  are  recorded,  of  almost 
total  suppression  for  two  or  three  months,  in  which  the 
patients  have  been  restored  to  health,  but  such  in 
stances  are  of  rare  occurrence,  and  should  only  be 
considered  in  the  light  of  exceptions  to  the  general 
law  of  the  disease. 

Suppression  now  and  then  occurs  from  the  presence 
of  calculi  or  gravel  in  the  structures  of  the  kidneys,  thus 
causing  a  mechanical  obstruction  to  the  healthy  per 
formance  of  their  functions.  In  these  cases  the  for 
eign  bodies  may  operate  by  causing  inflammation, 
spasms,  induration,  or  ulceration.  They  give  rise  to 
swelling,  pains,  sensation  of  weight  and  uneasiness  in 


AND    GENITAL    ORGANS.  445 

the  vicinity  of  the  kidneys,  to  numbness  of  the  thighs, 
retraction  of  the  testicles,  abdominal  tenderness,  con 
stipation,  frequent  inclination  to  urinate,  pain  and 
tenesmus  in  passing  water,  anxiety,  irritability,  febrile 
symptoms,  nausea,  vomitings,  hiccoughs,  pain  in  the 
lumbar  region,  pain  and  tension  in  the  perineum,  scald 
ing  in  the  urethra,  pulse  full  and  frequent,  difficulty  of 
breathing,  sighing,  delirium,  convulsions. 

Ischuria  may  be  distinguished  from  retention  of 
urine  from  the  circumstance,  that  in  the  latter  disease, 
the  bladder  is  distended  and  rises  up  above  the  pubis, 
offering  to  the  pressure  of  the  hand  a  firm  and  resist 
ing  body,  while  in  the  former  complaint  this  viscus  is 
empty,  falls  down  below  the  pubis,  and  affords  no 
resistance  or  fluctuation. 

Retention  of  urine  may  arise  from  inflammation,  from 
stricture  of  the  urethra,  from  paralysis  of  the  bladder, 
from  enlargement  and  inflammation  of  the  prostate 
gland,  from  mechanical  injuries  to  the  bladder,  from 
abuse  of  stimulating  diuretics,  from  inflammation  of 
the  rectum,  from  the  pressure  of  tumours,  from  dis 
placements  of  the  uterus,  from  calculi,  from  the  lodge 
ment  of  gravel  or  a  stone  in  the  ureters  or  in  the 
urethra,  from  thickening  and  obstruction  of  the  ureters, 
from  too  long  continued  retention  of  the  urine,  and 
from  spasms. 

The  general  symptoms  of  retention  are,  distention  of 
the  bladder,  and  its  elevation  above  the  pubis,  pains 
in  the  region  of  the  bladder,  with  pressing  desire  and 
frequent  ineffectual  attempts  to  urinate,  anxiety,  gen 
eral  uneasiness,  and  more  or  less  constitutional  dis 
turbance. 

As  retention  is  generally  but  a  symptom  of  some 
other  malady,  we  are  often  presented  with  constitu 
tional  disturbances  during  an  attack,  in  no  way  de 
pendent  upon  this  affection.  We  may  cite  as  exam 
ples  of  this  kind,  diseases  of  the  brain  and  spinal 
marrow,  which  may  have  preceded  the  retention  for 
months,  protracted  calculous  affections,  chronic  in 
flammations  of  the  bladder  and  of  the  prostate  gland, 
constitutional  effects  of  onanism,  retroversion  of  the 
uterus,  and  the  effects  of  previous  mechanical  injuries. 
From  these  facts  it  is  apparent  that  there  may  exist  an 


446  DISEASES    OJb    THE    URINARY 

almost  endless  variety  of  symptoms  during  the  pro 
gress  of  the  different  cases  of  retention  which  are  con 
stantly  occurring. 

When  the  malady  arises  from  simple  inflammation 
of  the  neck  of  the  bladder  or  of  the  bladder  itself,  not 
complicated  by  any  previous  disease,  the  symptoms 
are,  hot  skin  ;  frequent  and  hard  pulse  ;  thirst ;  pain 
in  the  region  of  the  bladder  and  in  the  perineum,  in 
creased  by  pressure  ;  restlessness  ;  anxiety  ;  constipa 
tion  ;  frequent  inclination  to  pass  water,  with  violent, 
painful  and  ineffectual  straining ;  shooting  pains  ex 
tending  up  the  ureters  towards  the  kidneys,  or  along 
the  spermatic  chords  towards  the  testicles ;  headache  ; 
nausea  ;  oppression  at  the  prrecordia ;  and  general 
feeling  of  fulness  and  distention  of  abdomen. 

Retention  caused  by  paralysis,  on  the  other  hand,  is 
accompanied  by  but  few  of  these  symptoms.  Indeed, 
many  cases  are  recorded,  where  the  accumulations  of 
urine  have  reached  an  enormous  amount,  before  the  pa 
tients  were  aware  of  it.  Other  instances  are  mentioned 
where  the  distention  has  been  so  gradual  and  painless 
as  to  cause  it  to  be  mistaken  for  ascites,  and  in  more 
than  one  instance  of  this  description,  paracentecis  ab- 
dominalis  has  been  resorted  to  as  a  curative  means. 
In  cases  like  these,  fifteen  or  twenty  pints  have  occa 
sionally  been  drawn  off  by  the  catheter  at  a  single 
operation.  It  is  not  an  uncommon  result  in  these  over- 
distentions,  for  the  bladder  to  become  united  by  adhesive 
inflammation  to  the  umbilicus,  and  afterwards  to  dis 
charge  itself  through  this  part  by  ulceration.  The 
same  occurrence  sometimes  takes  place  into  the  rec 
tum,  vagina,  and  even  into  the  abdominal  cavity.  In 
these  cases,  the  danger  from  peritoneal  inflammation, 
and  from  gangrene,  is  imminent. 

Retention  may  arise  from  spasmodic  contractions 
about  the  neck  of  the  bladder,  giving  rise  to  most  vio 
lent  and  painful  attempts  to  urinate,  bearing-down 
pains,  frequent  painful  erections,  great  sensitiveness 
of  the  urethra  and  perineum.  In  this  variety  of  re 
tention,  it  is  always  very  difficult  and  sometimes  ab 
solutely  impossible  to  pass  a  catheter,  without  pre 
viously  allaying  the  irritation  by  fomentations  or  by 
the  employment  of  suitable  medicines. 


AND  GENITAL  ORGANS.  447 

Spasmodic  retention,  although  sudden  and  violent 
in  its  onset,  is  not  usually  a  dangerous  affection.  The 
essence  of  the  disease  consists  in  an  irritation  about 
the  neck  of  the  bladder,  and  is  dependent  upon  in 
flammation  of  the  prostate,  of  the  rectum,  of  the  ure 
thra,  or  some  other  neighbouring  structure,  from 
which  it  has  been  propagated  by  contiguous  sym 
pathy. 

But  the  most  difficult  cases  of  retention  with  which 
the  physician  meets,  are  those  caused  by  strictures  of 
the  urethra,  and  enlargements  of  the  prostate  gland. 
The  practitioner,  during  his  professional  career,  will 
sometimes  be  called  to  cases  of  each  of  these  maladies, 
where  nothing  but  an  incision  into  the  membraneous 
portion  of  the  urethra,  through  the  stricture,  or  the 
puncture  of  the  bladder,  will  save  life.  In  these  cases, 
great  judgment,  decision,  and  surgical  skill,  are  indis 
pensable  to  the  safety  of  the  patient.  This  will  be  con 
ceded  when  we  think  of  the  rapidity  with  which  reten 
tion  may  terminate  in  fatal  cerebral  disease,  ulceration, 
and  gangrene.  By  these  observations,  we  by  no  means 
desire  to  deter  the  physician  from  the  employment  of 
every  medicinal  means  in  his  power,  so  long  as  they 
can  be  applied  without  endangering  the  life  of  the  pa 
tient  ;  but  there  is  a  point  beyond  which  we  cannot 
safely  pass  without  resorting  to  one  of  the  operations 
just  alluded  to,  and  in  making  up  a  correct  decision 
upon  this  point,  the  best  judgment  and  the  highest 
professional  knowledge  are  requisite.  I  cannot  bet 
ter  illustrate  this  subject  than  by  detailing  the  history 
of  a  case  which  came  under  my  observation  during  an 
early  part  of  my  professional  career  : 

Mr.  B.,  aged  forty  years,  of  robust  constitution,  had 
been  operated  upon  fourteen  years  previously,  for 
stricture  in  the  membraneous  part  of  the  urethra.  An 
incision  had  then  been  made  through  the  strictured 
part,  a  catheter  introduced  and  allowed  to  remain 
a  good  portion  of  the  time  for  several  weeks,  but  for 
some  unknown  reason,  the  opening  made  by  the  knife 
did  not  heal,  and  a  iistulous  passage  was  formed, 
through  which  the  urinn  has  passed  for  the  most  part 
of  the  time  since  that  ;>c;'iod.  For  two  or  three  years 
previous  to  his  coming  under  my  care,  this  fistulous 


448  DISEASES    OF    THE    URINARY 

passage  had  been  gradually  contracting,  and  he  expe 
rienced,  at  times,  retention,  which  could  only  be 
obviated  by  baths,  fomentations,  injections,  relax 
ing  medicines,  and  the  skilful  use  of  the  probe. 
Several  times,  however,  I  succeeded  in  relieving  him 
of  the  attacks,  by  these  means  ;  but  on  one  occasion, 
being  in  the  country,  and  having  contracted  a  cold 
from  wetting  his  feet,  the  retention  recurred,  accom 
panied  with  unusual  inflammation  and  tumefaction  in 
the  fistulous  tract.  Persevering  efforts  were  made  by 
his  medical  attendant,  to  allay  the  inflammation,  relax 
the  parts,  and  to  draw  off  the  water  by  means  of  ca 
theters  and  probes,  for  nearly  two  days,  but  without 
success.  The  symptoms  now  becoming  very  urgent, 
he  returned  home  and  placed  himself  under  the  care 
of  Dr.  Brigham  and  myself.  We  found  great  disten- 
tion  of  the  bladder,  constant  desire  to  urinate,  bearing- 
down  pains  in  the  region  of  the  bladder,  expression 
exceedingly  anxious  and  care-worn,  eyes  sunken, 
mouth  and  throat  dry,  thirst,  pulse  rapid  and  feeble, 
great  prostration,  nausea,  hiccough,  delirium,  frequent 
sighing,  exhalation  from  the  surface  of  the  body  of  a 
urinous  smell,  coldness  of  the  extremities,  and  a  slug 
gish  and  unhealthy  appearance  at  the  orifice  of  the 
fistula. 

After  resorting  to  the  usual  remedies  in  such  cases, 
and  making  repeated  attempts  with  the  catheter  and 
probe,  we  decided,  although  it  was  then  midnight,  that 
an  incision  must  be  made  through  the  perineum  with 
out  further  delay.  This  was  speedily  effected,  and 
the  patient's  life  thus  saved,  while  had  we  delayed  a 
few  hours  more,  gangrene  or  congestion  of  the  brain 
would  probably  have  resulted. 

We  also  have  in  mind,  a  case  of  retention,  from  en 
largement  of  the  prostate,  which  proved  fatal  in  con 
sequence  of  an  absolute  refusal,  on  the  part  of  the  pa 
tient,  to  .submit  to  the  operation  of  puncturing  the 
bladder.  In  this  instance,  the  swelling  and  inflamma 
tion  of  the  gland  were  so  great,  together  with  a  con 
stant  tendency  to  spasmodic  contraction  of  the  neck  of 
the  bladder,  whenever  the  catheter  came  in  contact 
with  the  part,  that  all  efforts  at  introduction,  aided  by 
baths,  fomentations,  and  relaxants,  were  of  no  avail. 


AND  GENITAL  ORGANS.  449 

Here,  a  timely  puncture  of  the  bladder,  would  have 
saved  the  patient's  life. 

We  are  well  aware  of  the  practical  skill  and  tact 
necessary  to  effect  an  introduction  of  a  catheter  in 
these  cases,  and  of  the  importance  of  securing  the  ser 
vices  of  a  skilful  and  experienced  surgeon  ;  but  cases 
sometimes  occur  which  baffle  the  most  eminent  sur 
geons  in  their  attempts  to  pass  a  catheter  by  an  en 
larged  prostate. 

Retention  sometimes  occurs  from  obstruction  of  the 
ureters,  by  gravel,  calculi,  by  thickening  and  indura 
tion  of  their  walls,  by  hydatids  and  other  unnatural 
formations,  by  the  pressure  of  tumours  in  their  vicinity, 
and  by  occlusion  from  adhesive  inflammation.  The 
following  signs  indicate  the  existence  of  this  variety  of 
disease  :  unusual  fulness,  pain  and  sensation  of  weight 
in  the  vicinity  of  the  kidneys,  tension  along  the  track 
of  the  ureters,  nausea,  vomiting,  retraction  of  the  tes 
ticles,  pain  along  the  spermatic  cord,  collapsed  state 
of  the  bladder,  no  resistance  to  the  introduction  of  the 
catheter,  absence  of  urine  in  the  bladder,  and  more  or 
less  constitutional  disturbance.  When  the  obstruction 
is  complete,  the  ureters  and  the  kidneys  become  so 
much  dilated  that  urine  to  the  amount  of  two  or  three 
pints,  sometimes  accumulates  in  them,  before  conges 
tion,  ulceration,  or  gangrene  supervene. 

Retention  not  unfrequently  arises  in  females,  from  a 
retroversion  of  the  uterus,  from  the  presence  within  the 
vagina  of  polypi,  hydatids,  of  schirrous  enlargements, 
from  injuries  arising  during  difficult  accouchements, 
from  the  irritation  caused  by  acrid  secretions,  from  the 
presence  of  hardened  fseces  in  the  rectum,  and  from 
adhesion  occurring  between  the  walls  of  the  vagina, 
in  consequence  of  inflammation  and  sloughing  of  the 
mucous  membrane. 

Causes. — The  most  frequent  proximate  cause  of  re 
tention,  is  inflammation  of  some  portion  of  the  bladder. 
Amongst  the  more  prominent  causes  of  this  inflamma 
tion,  are,  metastases  of  gout  and  rheumatism,  abuse  of 
diuretics,  mechanical  injuries,  injections,  venereal  dis 
eases,  calculi,  acrid  urine,  strains,  and  extension  of  in 
flammation  from  neighbouring  parts. 

The   causes   which   rank  next  in  importance,  are 


450  DISEASES    OP    THE    URINARY 

strictures  of  the  urethra.  They  occur  at  all  periods  of 
life,  and  always  require  the  interference  of  the  sur 
geon  for  their  removal. 

Enlargement  of  the  prostate  gland,  is  a  frequent  cause 
of  retention  in  old  men.  The  remote  cause  can  gene 
rally  be  traced  to  excesses  in  sexual  indulgence 
during  early  life.  This  gland  may  become  enlarged 
from  mere  inflammation  and  engorgement  of  its  struc 
ture,  or  from  schirrus  degeneration.  Affections  of  the 
prostate  are  usually  called  into  activity  by  undue  ex 
posure  to  cold  and  wet,  by  abuse  of  stimulants,  and 
by  neglect  of  timely  urinary  evacuations. 

Other  causes,  some  of  which  have  •  already  been  al 
luded  to,  are,  retroversion  of  the  uterus,  obstruction  of 
the  ureters  from  foreign  bodies,  occlusion  of  the  ureters 
from  adhesive  inflammation,  paralysis  of  the  bladder, 
from  injury  or  disease  of  the  brain  -or  spinal  marrow, 
from  undue  retention  of  urine,  from  mechanical  inju 
ries,  from  abuse  of  drugs,  from  metastases  of  gout, 
thickening  of  the  mucous  membrane  of  the  bladder, 
tumours  and  excrescences  near  the  neck  of  the  bladder, 
repercussed  eruptions,  pressure  upon  the  bladder  by 
tumours  in  its  vicinity,  schirrus  of  the  bladder  or  rec 
tum,  accumulations  of  hardened  faeces  in  the  rectum, 
suppression  of  the  menses,  phymosis,  ulcers,  external 
injuries,  blows,  contusions,  and  falls,  leucorrhoea  and 
gonorrliO3a. 

Therapeutics. — In  all  cases  of  suppression  or  reten 
tion,  where  there  can  exist  a  possible  doubt  in  regard 
to  the  true  nature  of  the  case,  we  should  avail  our 
selves,  without  delay,  of  the  use  of  the  catheter.  If 
this  instrument  passes  without  difficulty  into  the  ca 
vity  of  the  bladder,  and  no  discharge  of  urine  follows 
its  introduction,  we  may  be  certain  that  the  cause  and 
seat  of  the  difficulty  is  not  in  this  viscus  ;  while  if  a 
free  discharge  takes  place  through  the  catheter,  afford 
ing  immediate  relief  to  the  distention,  pain,  and  other 
unpleasant  symptoms  which  had  previously  existed, 
we  may  be  assured  that  the  bladder,  the  prostate 
gland,  or  some  part  of  the  urethra,  is  the  seat  of  the 
complaint. 

To  ensure  an  accurate  diagnosis,  then,  we  in  the  first 
instance  ascertain  whether  or  not  a  catheter  can  be 
passed  into  the  bladder. 


AND  GENITAL  ORGANS.  451 

Second.  If  it  can  be,  whether  easily  or  otherwise. 

Third.  How  large  an  instrument  can  be  passed. 

Fourth.  If  a  discharge  of  urine  follows  the  intro 
duction. 

Fifth.  If  the  operation  is  attended  with  pain. 

Another  important  step  in  forming  our  diagnosis, 
consists  in  procuring  from  the  patient  or  his  friends,  a 
minute  history  of  his  case,  and  every  circumstance 
connected  with  the  individual,  which  might  have  a 
bearing  upon  it.  Thus,  if  we  are  called  to  an  old  man, 
whose  malady  has  approached  gradually,  who  has  had 
no  febrile  symptoms  and  little  pain,  where  no  resist 
ance  is  offered  to  the  introduction  of  a  full-sized  ca 
theter,  and  where  a  large  quantity  of  urine  flows  off, 
affording  immediate  relief  to  the  uneasy  feelings,  we 
may  with  confidence  pronounce  the  cause,  paralysis  of 
the  bladder.  The  same  law  obtains  in  cases  of  re 
tention  succeeding  injuries,  or  diseases  of  the  spinal 
marrow. 

If  we  have  a  case  where  the  catheter  passes  into 
the  bladder  with  great  difficulty,  on  account  of  some 
obstruction  near  its  neck,  we  then  inquire  whether 
there  exists  a  stricture,  a  spasmodic  contraction  of  the 
neck  of  the  bladder,  or  an  enlarged  prostate  gland. 
The  following  circumstances  will  enable  us  to  decide 
the  question  satisfactorily: 

Stricture  approaches  gradually,  as  is  indicated  by 
the  gradual  contraction  of  the  stream  of  urine,  the 
frequent  and  sometimes  constant  presence  of  a  gleety 
discharge,  and  a  sensation,  after  passing  water,  as  if 
a  few  drops  still  remained  behind. 

Enlarged  prostate  occurs,  for  the  most  part,  in  old 
men,  is  attended  with  pulsative  pain  over  the  bladder, 
weight  in  the  perineum,  constant  inclination  to  uri 
nate,  with  much  straining,  fever,  and  general  uneasi 
ness.  By  introducing  the  finger  into  the  rectum,  we 
may  often  detect  the  enlargement  by  actual  touch. 

Spasmodic  contraction  of  the  neck  of  the  bladder 
usually  proceeds  from  inflammation  of  some  neigh 
bouring  structure,  as  the  prostate  gland,  the  rectum, 
and  the  urethra.  Spasms  of  this  part  may  arise  also 
from  the  irritation  of  gravel  and  calculi.  The  pre- 


452  DISEASES    OF    THE    URINARY 

vious  history  of  the  case  will  enable  us  to  decide  as  to 
the  real  cause  of  the  spasmodic  affection. 

Retention,  from  stricture  of  the  urethra,  can  only  be 
permanently  cured  by  the  gradual  dilatation  of  the 
contracted  part  by  bougies.  Temporary  relief  may 
sometimes  be  afforded  by  the  use  of  medicines,  but  the 
only  permanent  cure  is  by  artificial  dilatation.  But 
much  may  be  done  towards  effecting  cures  in  cases  of 
diseased  prostate,  by  a  judicious  employment  of  spe 
cific  medicines.  Many  cases  of  this  description  owe 
their  origin  to  scrofula,  or  to  a  venereal  taint,  or  to 
abuse  of  mercury,  or  to  schirrous  degeneration,  for 
which  reason  our  prescriptions  should  be  made  with 
reference  to  these  peculiar  states  of  the  system,  as 
well  as  to  the  more  immediate  symptoms  of  the  com 
plaint. 

With  regard  to  the  other  causes  of  retention,  the 
importance  of  a  minute  investigation  into  all  the  cir 
cumstances  of  each  case,  cannot  be  too  strongly  in 
sisted  on  ;  for  much  of  our  success  will  depend  upon 
an  early  removal  of  those  causes  which  have  operated 
to  induce  the  retention,  and  which  perhaps  continue 
to  exist  to  perpetuate  the  malady. 

If  a  retention  has  .  been  caused  by  a  metastasis  of 
gout  or  rheumatism,  our  selection  of  remedies  should 
be  made  with  reference  to  these  general  diseases,  as 
well  as  to  the  more  urgent  local  symptoms.  If  the 
cause  can  be  traced  to  a  displacement  of  the  uterus,  to 
impacted  faeces  in  the  rectum,  to  inflammation  of  any 
of  the  surrounding  tissues,  to  the  presence  of  asca- 
rides  in  the  rectum,  to  excrescences  about  the  neck  of 
the  bladder,  to  imperforate  hymen,  to  unnatural  ad 
hesions  within  the  vagina,  to  the  impaction  of  a  stone 
in  the  urethra,  our  attention  should  be  immediately 
directed  towards  the  removal  of  these  remote  causes. 

The  following  medicines  will  cover  all  of  the  symp 
toms  which  occur  in  suppression  or  retention  of  urine: 
cantharides,  cannabis,  uva  ursi,  solidago  virga  aurea, 
acid  phosphoric,  rhus  rad.,  aconite,  pulsatilla,  nux  vo- 
mica,  arnica,  belladonna,  oleum  terebinthina,  tussilago 
perluss.,  camphora,  agnus  castus,  arsenicum,  sulphur, 
iodine,  electro-magnetism. 

Cantharides  and  cannabis  are  indicated  in  supprcs- 


AND    GENITAL    ORGANS.  453 

sion  from  chronic  inflammation  of  the  kidneys,  and  in 
retention  from  long  continued  irritation  of  the  neck  of 
the  bladder.  They  may  also  be  employed  in  suppres 
sion  and  retention  from  acute  inflammation  of  the 
kidneys  and  bladder,  after  the  febrile  symptoms  have 
been  subdued  by  aconite.  Hahnemann  advises  them 
in  retention  from  paralysis  of  the  neck  of  the  bladder, 
and  in  cases  of  chronic  intention  arising  from  thicken 
ing  and  induration  of  the  mucous  membrane. 

Arnica  is  our  best  remedy  when  the  functions  of  the 
kidney  and  bladder  have  been  impaired  or  suspended 
by  mechanical  injuries,  falls,  contusions,  sprains, 
blows,  and  concussions,  or  by  the  irritation  of  calculi. 

Rhus  rad.,  belladonna,  and  solidago  virga  aurea,  are 
applicable  when  the  disorder  has  proceeded  from  me- 
tastases  of  gout  or  rheumatism.  These  medicines 
may  be  alternated  with  aconite  when  the  inflamma 
tory  symptoms  run  high. 

Agnus  castus  is  an  excellent  specific  in  retention 
in  consequence  of  paralysis  of  the  bladder.  Nux 
vomica,  tussilago,  arsenicum  and  oleum  terebinth.,  are 
remedies  which  should  command  attention  in  para 
lytic  retention. 

Spasmodic  retentions  are  readily  cured  by  camphor, 
belladonna,  and  aconite. 

When  gravel  or  calculi  are  the  exciting  causes  of 
the  affection,  we  advise  the  employment  of  uva  ursi, 
solidago  virga  aurea,  and  belladonna. 

Affections  of  the  prostate  gland  may  be  met  by 
pulsatilla,  sulphur,  aconite,  rhus  rad.,  arsenicum  and 
iodine. 

Retention  from  onanism,  or  excesses  in  venery,  are 
treated  best  with  acid  phosphoric,  agnus  castus,  can- 
tharides,  cannabis,  rhus  rad.,  and  arnica. 

Administration. — The  lower  attenuations  should  be 
employed  in  these  affections,  and  the  doses  repeated 
every  two,  three,  or  four  hours,  until  the  medicinal 
effect  is  perceptible.  Auxiliary  to  the  above  medi 
cinal  treatment,  we  make  a  thorough  use  of  warm 
baths,  fomentations,  bland,  diluent  drinks,  injections 
by  the  rectum,  and  lastly,  though  by  no  means  the 
least  important  means,  electro-magnetism.  This  power 
ful  remedy  should  only  be  employed  after  the  inflam- 


454  DISEASES    OF    THE    URINARY 

matory  symptoms  have  been  reduced,  and  then  with 
extreme  care  and  moderation. 

SECTION    VI. 

DYSURIA. 

Diagnosis. — In  this  complaint  the  urine  can  be 
voided  at  will,  but  it  usually  passes  away  in  a  small 
spiral,  or  divided  stream,  or  drop  by  drop,  each  act 
being  attended  with  burning  and  cutting  pains  at  the 
neck  of  the  bladder.  There  is  a  frequent  inclination 
to  urinate,  and  sensations  of  pressure  and  tenesmus, 
which  constantly  urge  the  patient  to  void  his  urine. 
The  inflammation  is  confined  to  the  neck  of  the  blad 
der,  and  does  not  often  give  rise  to  constitutional  dis 
turbance. 

Causes. — Perhaps  the  most  frequent  cause  of  dysuria 
is  the  absorption  of  cantharides.  This  substance 
exercises  a  specific  influence  so  decidedly  upon  the  neck 
of  the  bladder,  that  even  a  sufficient  quantity  may  be 
absorbed  from  the  external  application  of  blisters  to 
cause  the  malady.  Other  causes  are,  stimulating  in 
jections,  abuse  of  stimulants  and  condiments,  onanism, 
extension  of  gonorrhoaal  inflammation,  cold,  turpen 
tine,  worms  in  the  rectum,  gravel,  and  calculi. 

Therapeutics. — Camphor  is  the  specific  against  dy- 
sury  caused  by  the  absorption  of  cantharides.  When 
arising  from  other  causes,  cannabis,  uva  ursi,  digitalis, 
solidago  virga  aurea,  cantharides,  and  terebinth,  are 
worthy  of  confidence. 

Administration. — Same  as  in  retention,  &c. 

SECTION  VII. 

URINARY      CALCULI. 

There  is  not  space  in  a  manual  of  this  description  for 
the  careful  consideration  which  is  demanded  for  this  dis 
ease  by  its  importance ;  but  we  shall  endeavour  to  glance 
hastily  at  the  most  prominent  doctrines  at  present  in 
vogue,  with  a  view  of  attracting  attention  more  par 
ticularly  to  the  subject,  rather  than  from  any  expecta 
tion  of  affording  a  satisfactory  explanation  of  the 
phenomena  attending  the  formation  and  development 


AND  GENITAL  ORGANS.  455 

of  calculous  concretions.  Chemistry  has  indeed  af 
forded  us  much  accurate  knowledge  respecting  the 
composition  of  the  different  varieties  of  calculi,  but 
we  still  remain  in  ignorance  of  the  real  causes  and 
nature  of  the  abnormal  action,  the  peculiar  condition 
of  the  organism  requisite  to  originate  this  action,  and 
of  the  specific  medicines  capable  of  effecting  cures. 
The  data  upon  which  modern  physicians  have  found 
ed  their  prescriptions,  may  be  more  scientific  and  ac 
curate  than  those  of  the  ancients,  but  we  are  not  aware 
that  the  practical  results  which  they  have  obtained  are 
in  any  degree  more  decided  or  favourable.  The  an 
cient  allopathists  attributed  the  formation  of  stone  to 
the  union  of  the  "terrestrial  and  tartarous  parts  of  the 
blood  with  the  clamminess  of  the  viscous  lymph  a,  that 
continually  flows  by  with  the  urine,  and  further  com 
pacted  together  by  the  salts  with  which  the  urine  is 
leaden"*  And  for  the  cure,  they  prescribed  venesection, 
opiates,  mercurials,  diuretic  infusions  and  decoctions, 
and  "  litliontriptics"  or  "  stone-dissolving  remedies." 
Modern  allopathy  attributes  calculous  depositions  to 
a  superabundance  of  uric  acid,  of  the  phosphates  of 
lime,  magnesia,  and  ammonia,  oxalate  of  lime,  <fec.,  in 
the  blood  and  urine,  and  they  also  prescribe  blood 
letting,  opiates,  mercurials,  diuretics,  and  "  stone-dis 
solving  remedies"  but  with  no  more  success  than  their 
heathen  predecessors.  To  what  extent  homoeopathy 
may  be  able  to  combat  this  formidable  disease,  time 
alone  can  determine  ;  but  so  far  as  the  limited  ob 
servations  and  experience  of  our  practitioners  extend, 
in  this  class  of  affections,  our  method  of  practice  has 
been  highly  satisfactory.  Our  system  is  especially 
adapted  to  correct  those  peculiar  diatheses  upon 
which  the  formation  of  calculi  depend. 

Calculous  affections  have  been  observed  to  prevail 
in  some  countries  more  than  others  :  even  in  some 
portions  of  the  same  country  they  may  be  common, 
while  in  other  sections  they  will  be  unknown.  The 
disease  is  rarely  seen  in  very  cold  or  very  hot  latitudes. 
English  surgeons  assert  that  it  never  originates  in  the 
East  Indies,  and  it  is  supposed  to  be  of  very  rare  oc 
currence  in  the  northern  kingdoms  of  Europe. 

*  Salmon. 


456  DISEASES    OF    THE    URINARY 

Children  and  old  people  are  most  subject  to  the  dis 
ease,  and  it  seizes  especially  upon  those  in  whom  gout 
is  hereditary.  Indeed  this  gouty  diathesis  is  so  com 
mon  in  individuals  afflicted  with  calculi,  that  many 
suppose  that  the  urine  exercises  but  little  if  any  influ 
ence  in  their  formation,  but  that  metastases  of  gout  to 
the  mucous  membrane  of  the  urinary  passages,  deter 
mine  the  formations  of  these  calculous  concretions.  — 
Thus,  Frank,  in  his  "  Traite  de  Prac.  de  Med.,"  p.  367, 
vol.  ii,"  says  :  "  The  attacks  of  calculous  affections, 
like  those  of  gout,  are  preceded  and  accompanied  by 
languor  of  the  stomach,  nausea,  oppression,  eructa 
tions,  borborigrni.  In  inveterate  gout,  this  phlegma- 
sia  gives  rise  to  calcareous  concretions,  formed  of  a 
material  combined  with  uric  acid,  and  which  do  not 
differ  from  urinary  calculi  except  in  consistency  and 
form.  Suppose  now  that  fixed  gout,  which  produces 
calcareous  concretions  in  the  articulations  of  the 
great  toe,  attacks  the  mucous  membrane  of  the  blad 
der,  may  it  not  become  the  source  of  calculi  in  this  vis- 


Calculi  have  been  found  in  the  brain,  lungs,  liver, 
spleen,  gall,  bladder,  uterus,  the  articulations  and  the 
soft  parts  of  nearly  every  portion  of  the  organism,  but 
the  urinary  organs  are  by  far  the  most  common  seat 
of  these  formations.  Several  years  since  I  saw  taken 
from  the  upper  part  of  the  left  lobe  of  the  lung  of  a 
miller,  two  concretions  of  a  chalky  appearance,  but 
hard  and  tough,  and  of  the  size  of  a  goose-egg.  Con 
cretions  of  lithate  of  ammonia  are  also  common  in  all 
parts  of  the  body,  in  gouty  patients. 

Prout  has  divided  the  mechanical  deposits  from  the 
urine  into  three  classes  :  First,  Pulverulent,  or  amor 
phous  sediments.  Second,  Chrystaline  sediments,  usu 
ally  denominated  gravel.  Third,  Solid  concretions  or 
calculi,  formed  by  the  aggregation  of  these  sediments. 

The  sediments  of  the  first  class  are  held  in  solution 
by  the  urine  until  it  is  discharged  from  the  bladder, 
when  they  are  gradually  deposited  in  a  state  of  fine 
brown  or  yellow  powder.  These  sediments  are  gen 
erally  composed  of  "  two  species  of  neutral  saline 
compounds  ;  viz.,  the  lithates  of  ammonia,  soda,  and 
lime,  tinged  more  or  less  with  the  colouring  principle 


AND  GENITAL  OBGANS.  457 

of  the  urine,  and  with  the  purpurates  of  the  same  ba 
ses,  and  constituting  what  are  usually  denominated 
pink  and  laterilious  sediments;  and  secondly,  the 
earthy  phosphates,  namely,  the  phosphate  of  lime,  and 
the  triple  phosphate  of  magnesia  and  ammonia,  con 
stituting,  for  the  most  part,  sediments  nearly  white. 
The  two  species  of  sediments  are  frequently  mixed  to 
gether."—  (Prout.) 

The  sediments  of  the  second  class,  or  gravel,  are 
found  in  the  urine  in  regularly  crystallized  grains,  va 
rying  in  form  and  colour  in  accordance  with  the  con 
stituents  of  which  they  are  composed.  The  lithic  acid 
crystals  are  much  the  most  common,  and  may  be  dis 
tinguished  by  their  red  colour.  The  crystals  of  the 
triple  phosphate  of  ammonia  and  of  magnesia  are  of 
a  white  colour,  while  those  of  the  oxalate  of  lime  are 
black  or  dark  green. 

Prout  supposes  that  two-thirds  of  the  whole  number 
of  calculi  originate  from  lithic  acid ;  and  when  we  bear 
in  mind  the  constant  presence  of  this  acid  in  the  urin 
ary  organs,  and  its  proneness  to  form  hard,  inodorous 
concretions  of  a  yellowish  or  brown  colour,  the  suppo 
sition  will  not  appear  unreasonable. 

Chemists  have  described  many  different  varieties  of 
calculi,  amongst  which  the  following  are  the  most  com 
mon: — 

First,  The  lithic  or  uric  acid  calculus,  formed  by  con 
centric  lamellae,  presenting  a  light  brown  or  reddish 
colour,  and  a  general  appearance  something  like  wood. 
These  calculi  are  infusible  by  the  blow-pipe,  but  may 
be  slowly  evaporated,  until  a  slight  residue  of  white 
ash  remains.  They  are  soluble  in  alkaline  solutions, 
which,  on  this  account,  are  supposed  to  be  valuable  as 
remedial  agents,  but  they  are  not  dissolved  by  muri 
atic  or  sulphuric  acids.  The  lithic  acid  diathesis  pre 
vails  in  childhood  and  at  about  the  age  of  forty  or  fifty, 
and  the  urine  voided  in  these  cases  is  generally  acid, 
and  the  sabulous  sediment  of  a  red  colour. 

Second.  The  calculi  of  most  common  occurrence  af 
ter  the  variety  last  described,  are  those  composed  of  a 
triple  combination  of  phosphoric  acid,  magnesia,  and 
ammonia.  They  are  of  a  lightish  gray  colour,  indis 
tinctly  laminated,  with  an  "  uneven  surface  and  cov- 
20 


458  DISEASES    ©F   THE   URINARY 

ered  with  small  shining  crystals."  This  variety  is 
not  soluble  in  alkaline  solutions,  but  may  be  partially 
dissolved  by  muriatic,  nitric,  and  sulphuric  acids,  and 
imperfectly  fused  by  the  blow-pipe.  The  urine  in  these 
cases  is  very  fetid,  and  the  sediment  deposited  of  a 
white  colour,  "  resembling  mortar."  Sir  Astley  Cooper 
asserts  that  this  kind  of  calculus  is  very  apt  to  be  re 
produced  after  lithotomy,  and  on  this  account  advises 
the  postponement  of  operations  in  these  cases  until  the 
morbid  diathesis  is  corrected. 

Third.  Not  a  very  uncommon  variety  is  the  mulber 
ry  calculus,  of  a  dark  brown  colour,  uneven  surface, 
and  very  compact,  heavy  and  hard.  It  consists  of  ox- 
alate  of  lime,  and  is  partially  soluble  in  muriatic  and 
sulphuric  acids,  but  the  alkaline  solutions  have  no  ef 
fect  upon  it. 

Fourth.  The  phosphate  of  lime  calculus  is  in  a  few 
instances  found  pure,  but  usually  it  exists  in  combina 
tion  with  uric  acid  and  phosphate  of  magnesia  and 
ammonia.  It  is  laminated,  polished,  of  a  pale  brown 
colour,  soluble  in  muriatic  or  nitric  acid,  and  may  be 
fused  by  the  blow-pipe.  They  are  of  small  size,  and 
are  generally  found  in  the  prostate  gland. 

Fifth.  The  cystic  oxyde  calculus  is  another  variety 
of  rare  occurrence,  of  a  yellowish  hue,  not  laminated, 
soluble  in  acids  and  alkaline  solutions,  and  emitting 
under  the  blow-pipe  a  fetid  odour. 

Sixth.  There  is  also  the  fusible  calculus,  composed 
of  a  mixture  of  the  triple  phosphate  of  magnesia  and 
ammonia,  and  of  the  phosphate  of  lime  ;  of  a  white 
colour,  and  fusible  by  the  blow-pipe.  This  kind  of 
calculous  deposit  is  occasionally  seen  between  the 
foreskin  and  glans-penis  in  old  cases  of  phymosis. 

Seventh.  The  constituents  of  the  different  kinds  of 
calculi  are  sometimes  deposited  in  distinct  alternate 
layers  in  the  same  stone,  when  it  is  called  the  alterna 
ting  calculus. 

Other  varieties  have  been  described,  like  the  com 
pound  calculi,  the  carbonate  of  lime  calculus,  the  lithate 
of  ammonia  calculus,  &c. 

The  presence  in  the  bladder  or  kidneys  of  any  solid 
.substance,  whether  introduced  artificially,  or  formed 
naturally  from  lithic  acid  concretions,  or  clots  of  blood, 


AND  GENITAL  ORGANS.  459 

favours  the  formation  of  calculi.  Whether  the  cause 
of  these  deposits  in  the  urinary  organs,  is  attributable 
to  the  peculiar  composition,  or  the  compact  structure, 
or  the  comparative  temperature  of  the  nuclei,  we 
are  unable  to  determine  :  but  all  are  aware  of  the  fact, 
that  catheters,  bullets,  splinters,  or  other  solid  substan 
ces,  accidentally  introduced  into  the  bladder,  become 
speedily  coated  over  with  the  urinary  sediments,  which 
are  converted  into  hard  crusts. 

Calculi  are  more  frequently  observed  in  the  male, 
than  in  the  female  sex ;  but  this  circumstance  has 
been  attributed  to  the  difference  in  the  structure  of  the 
urethra  in  the  two  sexes,  rather  than  to  a  difference  in 
the  original  diathesis.  The  urethra  of  the  female  be 
ing  short  and  easily  dilated,  gives  passage  without 
difficulty  to  gravel  and  small  calculi,  which  in  the  long 
and  contracted  male  organs  would  be  obstructed  either 
by  causing  spasmodic  contractions,  or  from  an  actual 
want  of  room  to  pass. 

It  is  said  that  the  right  kidney  is  far  more  common 
ly  the  seat  of  these  formations  than  the  left,  that  their 
form  is  generally  spheroidical,  and  that  their  ave 
rage  weight  is  from  one  to  two  ounces.  Sir  Astley 
Cooper,  however,  expresses  the  opinion  that  a  majori 
ty  of  urinary  calculi  weigh  less  than  one  ounce  each. 

Calculi  may  originate  in  the  kidneys,  the  bladder, 
or  the  prostate  gland,  but  the  first  organ  is  the  prima 
ry  seat  of  a  large  majority  of  cases,  as  is  evident  from 
the  fact  that  the  pains  are  almost  always  confined  to 
the  region  of  one  of  the  kidneys  in  the  first  instance. 
It  is  probable  that  the  nuclei  of  most  stones  found  in 
the  bladder,  are  first  formed  in  the  kidneys,  and  then 
conveyed  through  the  ureters  into  this  viscus,  to  serve 
as  the  foundation  of  still  farther  deposits  from  the 
urine. 

Diagnosis. — A  calculus  may  remain  in  the  kidney 
or  bladder  for  a  long  time,  without  exciting  much  pain 
or  uneasiness.  The  patient  experiences  perhaps  a 
more  frequent  inclination  to  urinate  than  natural,  and 
after  violent  exercise  on  horseback  or  in  a  carriage, 
has  temporary  pains  in  the  region  of  the  organ  affect 
ed,  but  in  other  respects  he  feels  well.  This  state  of 
things  may  exist  for  an  indefinite  length  of  time,  when, 


460  DISEASES  OF  THE  URINARY 

if  the  stone  is  situated  in  the  kidney,  some  exciting 
cause  may  operate,  and  give  rise  to  what  is  denomi 
nated  a  "fit  of  the  stone."  In  these  instances  the  pa 
tient  is  usually  attacked  suddenly,  with  severe  cutting 
pains  in  the  region  of  the  kidney,  which  increases  as 
the  stone  passes  along  the  ureter  to  the  bladder,  some 
times  extending  to  the  groin,  the  cremaster  muscle, 
or  along  the  crural  nerve,  as  it  passes  over  the  nerves 
connected  with  these  parts.  During  the  paroxysm, 
the  pain  is  often  of  the  most  violent  and  intolerable 
character,  and  is  accompanied  with  continual  nausea, 
vomiting,  inability  to  retain  any  thing  upon  the  sto 
mach,  frequent  desire  to  urinate,  high  coloured  and 
sometimes  bloody  urine,  bent  position  of  the  body,  with 
the  muscles  flexed  as  much  as  possible,  heartburn, 
painful  retraction  of  the  testicle,  irritable  bladder, 
and  febrile  symptoms.  There  is  often  a  remission  of 
these  symptoms  for  a  longer  or  shorter  period,  during 
the  descent  of  the  stone  through  the  ureters,  and  the 
paroxysm  now  and  then  comes  on,  and  subsides  sud 
denly  and  permanently,  the  stone  not  having  effected 
an  entrance  into  the  ureter. 

After  the  stone  has  passed  into  the  bladder,  we 
have  the  following  train  of  symptoms  :  frequent  incli 
nation  to  urinate,  "  the  patient  making  the  first  por 
tion  with  ease,  and  complaining  of  great  pain  coming 
on  when  the  last  drops  are  expelled." — (Earle.)  Sud 
den  stoppage  of  the  current  of  urine,  in  consequence 
of  the  stone  moving  in  front  of  the  urethra,  itching 
and  tingling  at  the  extremity  of  the  penis,  difficulty 
or  absolute  inability  of  retaining  the  faeces  when  uri 
nating,  on  account  of  the  sympathetic  irritation  of 
the  rectum,  "sense  of  weight  and  pressure  at  the 
lower  part  of  the  pelvis,"  dull  pain  at  the  neck  of  the 
bladder,  bloody,  mucous,  or  purulent  urine,  pains  in 
the  region  of  the  bladder  increased  by  exercise,  espe 
cially  riding  on  horseback  or  in  a  jolting  carriage, 
febrile  symptoms,  irritability,  loss  of  appetite,  emacia 
tion,  inability  to  sleep  or  rest  quietly,  night  or  day. 
In  boys,  the  prepuce  generally  becomes  much  elon 
gated,  from  their  constant  habit  of  pulling  at  it,  to 
relieve  the  itching  in  the  glans.  After  the  stone  has 
continued  in  the  bladder  for  a  considerable  time,  this 


AND  GENITAL  ORGANS.  461 

organ  becomes  very  much  contracted,  its  coats  be 
come  thickened  and  diseased,  and  the  patient  sinks 
under  the  constitutional  derangement  consequent 
upon  the  protracted  irritation  of  the  foreign  body. 

It  will  be  observed  that  all  of  the  symptoms  which 
we  have  enumerated,  are  similated  by  the  affections 
of  the  urinary  organs.  Thus,  simple  nephritis  gives 
rise  to  the  symptoms  of  calculus  in  the  kidneys ;  and 
inflammation  of  the  prostate  gland  and  bladder,  to 
those  of  stone  in  the  bladder.  But  in  some  instances 
the  patient  can  actually  feel  the  motion  of  the  calcu 
lus,  as  he  turns  over  from  one  side  to  the  other.  This 
circumstance,  taken  in  connection  with  the  abrupt 
stoppage  of  the  stream  when  urinating,  in  conse 
quence  of  the  stone  getting  before  the  urethra,  and 
the  occurrence  of  severe  pain  after  the  urine  has  been 
mostly  evacuated,  in  consequence  of  the  stone  coming 
into  more  direct  contact  with  the  walls  of  the  bladder, 
will  enable  us  to  decide  with  much  certainty  respect 
ing  the  presence  of  a  stone. 

But  the  only  positive  indication  of  a  calculus  is  our 
ability  to  strike  it  with  a  sound  introduced  into  the 
bladder,  and  a  prudent  surgeon  will  never  cut  for  the 
stone  unless  he  can/ee/  it  with  his  sound  immediately 
before  he  commences  his  operation. 

Therapeutics. — Our  therapeutical  measures  may  be 
classed  under  four  heads. 

First.  To  correct  the  diathesis  on  which  the  mor 
bid  sediments  depend. 

Second.  To  relieve  the  distress  and  suffering  at 
tendant  on  the  presence  in  the  urinary  organs  of  gra 
vel  or  stone. 

Third.    To  dissolve  the  stone. 

Fourth.  To  extract  it,  either  by  lithotomy,  or  by 
the  aid  of  Civiale's  lithotriptor. 

The  first  object  may  be  attained  by  removing  the 
causes  upon  which  the  diathesis  depends.  Some  of 
the  more  prominent  of  these  causes  are,  errors  in  diet, 
including  quality  and  quantity  of  food,  and  irregu 
larity  in  hours  of  taking  meals,  abuse  of  stimulants, 
use  of  water  abounding  in  lime,  excessive  mental  or 
bodily  fatigue,  undue  exposure  to  atmospheric  vicissi 
tudes,  insufficient  nutriment,  the  depressing  passions, 


462  DISEASES  OF  THE  URINARY 

tendency  to  gout  and  rheumatism,  dyspepsia,  and  dis 
ease  of  the  urinary  organs. 

When  the  depositions  depend  upon  a  lithic  acid  dia 
thesis,  every  thing  of  an  acid  nature  should  be  avoid 
ed;  a  large  quantity  of  animal  food  should  be  en 
joined,  and  baths,  frictions,  and  abundant  exercise 
taken,  to  ensure  a  healthy  action  of  the  skin. 

The  phosphatic  diathesis  may  depend  upon  a  loss  of 
tone  in  the  digestive  organs,  too  free  use  of  animal 
food,  profuse  sweats,  use  of  lime  water,  and  over- 
exertion,  mental  or  physical.  Here  a  farinaceous 
and  vegetable  diet,  and  a  free  use  of  fruit  and  acids, 
should  be  advised.  If  the  depositions  arise  from  gout 
attacking  the  mucous  membrane  of  the  bladder,  the 
suitable  medicines  will  speedily  dissipate  the  morbid 
condition,  When  the  diathesis  appears  to  proceed 
from  general  debility,  or  derangement  in  the  digest 
ive  or  assimilative  functions,  our  dietetic  regulations, 
as  well  as  our  medicines,  should  be  prescribed  with 
reference  to  these  conditions. 

In  all  calculous  affections,  a  cheerful  state  of  mind, 
with  country  air,  or  a  sea-voyage  to  a  hot  or  cold  lati 
tude,  will  prove  serviceable. 

To  fulfil  the  second  and  third  indications  as  far  as 
possible,  we  shall,  farther  on,  point  out  those  reme 
dies  which  we  deem  most  suitable.  But  it  is  matter 
of  much  doubt  whether  there  are  at  present  any 
remedies  known,  capable  of  dissolving  a  calculus 
in  the  urinary  organs  after  it  has  attained  a  con 
siderable  size.  We  may  be  able  to  correct  the 
diathesis  upon  which  the  morbid  sediments  depend, 
and  to  enable  the  urinary  organs  to  expel  calculi 
of  small  size  ;  but  the  dissolution  of  a  large  stone 
in  the  bladder  has  never  yet  been  effected.  Such 
can  only  be  removed  by  crushing  them  according 
to  the  method  of  Civiale,  &c.,  so  that  the  fragments 
will  pass  off  by  the  urine,  or  by  the  operation  of 
lithotomy.  For  the  details  concerning  these  im 
portant  operations,  we  refer  the  reader  to  the  standard 
works  on  Surgery. 

The  principal  medicines  in  the  treatment  of  urinary 
concretions,  are  cannabis,  uva  ursi,  nux  vomica,  sarsa- 
parilla,  lycopodium,  calcarea  carb.,  phosphorus,  aspara- 


AND  GENITAL  ORGANS.  463 

gine,  monarda  punctata,  alchemilla  arveusis,  chininum 
sulph.,  alisma  plantago. 

Cannabis  and  uva  ursi  are  excellent  remedies  dur 
ing  a  fit  of  the  gravel,  accompanied  with  painful  mic 
turition  ;  discharge  of  slimy,  purulent  or  bloody  urine  ; 
burning  in  the  bladder  and  urethra  during  and  after 
micturition ;  and  itching  at  the  extremity  of  the  glans 
penis. 

Dr.  Gross  has  highly  commended  the  employment 
of  nux  vomica  and  sarsaparilla  for  the  cure  of  gravel 
and  calculous  affections.  So  far  as  the  former  remedy 
is  concerned,  my  own  experience  coincides  with  that 
of  Dr.  Gross.  I  have  in  several  instances  prescribed 
nux  vomica  with  unequivocal  benefit,  in  calculous  af 
fections  which  apparently  originated  from  chronic 
derangement  of  the  digestive  organs.  In  one  case, 
likewise,  where  the  patient  experienced  the  most  se 
vere  spasmodic  pains  from  the  passage  of  a  calculus 
from  the  kidney  to  the  bladder,  with  constant  nausea, 
vomiting,  painful  and  bloody  micturition,  and  high- 
coloured  urine,  the  most  prompt  and  happy  results  fol 
lowed  the  use  of  nux. 

This  remedy  is  decidedly  indicated  when  lithiasis 
arises  from  dyspeptic  symptoms,  sedentary  occupa 
tions,  abuse  of  stimulants,  excesses  in  eating,  and  also 
for  the  acute  constrictive  and  spasmodic  pains  which 
proceed  from  the  irritation  of  a  calculus  when  passing 
from  one  point  to  another. 

Lycopodium  is  adapted  to  patients  of  a  lymphatic 
temperament,  and  who  have  been  subject  to  chronic 
affections  of  the  mucous  membranes.  The  lycopodium 
pains  occur  mostly  in  the  urethra  and  perineum^  and 
are  of  a  burning,  smarting,  or  cutting  character  during 
micturition.  The  urine  is  of  a  dark  colour,  very  foetid 
and  deposites  a  red  or  yellowish  sand. 

Calcarea  carb.  is  suitable  for  the  calculous  affec 
tions  of  scrofulous  or  chlorotic  children.  It  is  indica 
ted  when  the  pains  in  the  urinary  organs,  and  the 
desire  to  pass  water,  are  worse  during  the  night,  and 
the  urine  is  of  a  dark  colour,  foetid,  and  deposites  a 
white  sediment.  Calcarea  is  also  indicated  in  debility 
of  the  assimilative  functions,  emaciation,  and  great 
weakness  and  exhaustion  of  the  whole  system. 


464  DISEASES    OF    THE    URINARY 

Phosphorus  may  be  given  in  lithiasis  occurring  in 
broken  down  constitutions  from  loss  of  fluids,  and  in 
old  and  debilitated  subjects.  The  phosphorus  symp 
toms  are  characterized  by  loss  of  power  over  the  uri 
nary  organs,  involuntary  passing  of  urine  and  fasces 
at  the  same  time,  sudden  interruptions  of  the  course  of 
the  urine,  desire  to  urinate,  with  dull  pains  in  the 
hypogastrium,  emission  by  the  urine  of  an  ammoniacal 
odour,  and  deposites  of  a  whitish  or  brick-dust  sedi 
ment. 

We  have  exhibited  asparagus  in  two  cases  of  lithia 
sis  dependent  upon  a  gouty  diathesis  with  marked 
success.  In  one  of  these  cases  the  calculous  symptoms 
all  disappeared  in  a  few  weeks  after  commencing  the 
medicine,  and  the  morbid  character  which  the  urine 
had  presented  for  several  years,  was  entirely  changed 
to  a  healthy  condition.  We  are  inclined  to  believe 
that  asparagus  is  a  remedy  of  much  greater  power  in 
urinary  affections  and  in  dropsies,  than  has  ever  been 
attributed  to  it.  Our  experience  with  it  in  those 
maladies  has  been  somewhat  extensive,  and  generally 
of  a  most  satisfactory  character.  It  is  especially 
called  for  when  there  is  frequent  inclination  to  urinate ; 
burning  and  cutting  in  the  urethra  and  kidneys  ;  dull 
drawing  pains  in  the  groin  ;  tenderness  and  pain  in 
the  perineum ;  sensation  as  if  urine  was  passing  off, 
after  all  has  been  discharged  ;  urine  straw-coloured 
or  brown,  with  a  very  offensive  smell,  and  a  whitish 
sediment ;  palpitation  of  the  heart ;  rapid  and  oppress 
ed  respiration  on  the  slightest  exertion. 

Monarda  punctata,  alchemilla  arveusis,  and  alisma 
plantago,  also  cover  most  of  the  symptoms  enumerated 
under  asparagus,  and  may  sometimes  succeed  this 
remedy  with  advantage. 

Chininum  sulph.  is  recommended  when  there  are  mi 
nute  crystallized  grains  in  the  urine,  of  a  reddish  or 
yellowish  colour ;  increased  flow  of  acrid  and  offensive 
urine  ;  emaciation ;  irritability  and  much  constitu 
tional  disturbance. 

Administration. — During  the  violent  paroxysms 
which  occur  in  calculous  diseases,  we  may  employ 
the  medicines  from  the  first  to  the  third  attenuation, 
and  repeat  every  hour  until  the  desired  impression  is 


AND  GENITAL  ORGANS.  465 

produced.     But  under  ordinary  circumstances,  a  dose 
once  in  twelve  or  twenty-four  hours  will  suffice. 

SECTION  VIII. 

URETHRITIS. INFLAMMATION    OF    THE    URETHRA. 

The  term  gonorrhoea,  derived  from  two  Greek  words, 
yW,  semen,  and  £«*>,  to  flow,  is  very  generally  used  by 
American  and  English  physicians  to  designate  this 
malady.  Dr.  Swediaur,  perceiving  the  erroneous  im 
pression  which  this  definition  might  convey,  substitu 
ted  another  term  no  less  etymologically  inaccurate, 
blennorrhcza,  or  blennorrhagia,  derived  from  two  other 
Greek  words,  BA/W*,  mucus,  and  '^e*,  to  flow.  But  as 
modern  researches  have  demonstrated  that  the  in 
voluntary  discharge  which  is  a  characteristic  of  this 
disease,  does  not  consist  of  semen  or  mucus,  but  of  a 
purulent  and  infectious  matter,  we  think  the  erro 
neous  terms  commonly  employed  to  designate  the  com 
plaint,  should  be  abolished.  Many  reasons  may  be 
adduced  against  naming  the  affection  from  the  sup 
posed  character  of  the  discharge  ;  for,  notwithstand 
ing  as  a  general  rule  it  is  decidedly  purulent,  cases 
occasionally  occur  where,  from  the  intensity  of  the 
inflammation,  there  is  no  discharge  at  all,  and  consti 
tuting  that  form  of  the  disease  denominated  by  French 
writers,  "  blennorrhagie  seche"  The  matter  is  like 
wise  sometimes  composed  of  a  mixture  of  pus,  mucus, 
semen  and  blood.  For  these  reasons  we  prefer  to 
make  use  of  the  more  general  term,  urethritis.  In 
flammation  of  the  urethra  may  indeed  arise  from  other 
causes  than  the  application  of  infectious  matter  during 
an  impure  connection,  and  present  all  of  the  symp 
toms  peculiar  to  the  venereal  inflammation,  but  the 
malady  is  none  the  less  urethritis  on  this  account,  al 
though  the  secretion  accompanying  the  inflammation 
is  not  infectious.  So  may  an  inflammation  of  the  eye 
owe  its  origin  to  the  application  of  venereal  matter, 
external  irritants,  atmospheric  changes,  injuries,  scro 
fula,  and  abuse  of  stimulants,  and  yet  notwithstand 
ing  these  different  causes,  the  disease  is  none  the  less 
ophthalmia. 

All  secreting  surfaces  are  liable  to  be  irritated  when 
20* 


466  DISEASES    OF    THE    URINARY 

operated  on  by  certain  unnatural  stimuli.  The  mu 
cous  membrane  of  the  throat,  the  bronchia,  the  lungs, 
the  nostrils,  the  frontal  sinuses,  and  the  conjunctiva  of 
the  eye,  are  all  subject  to  different  grades  and  kinds 
of  inflammation,  and  their  secretions  to  become  changed 
in  quality  and  quantity,  according  to  the  morbid  cause 
which  has  been  in  operation.  The  lining  membrane 
of  the  urethra  is  also  subject  to  the  same  laws  :  it  may 
become  inflamed  and  pour  out  a  purulent  discharge 
from  the  presence  of  calculi  in  the  bladder,  from  gout 
and  rheumatism,  from  acrid  urine,  from  the  absorption 
of  certain  diuretics,  from  ulcers,  from  mechanical  in 
juries,  and  finally  from  the  application  of  infectious 
matter  during  an  impure  coition.  In  a  very  large  ma 
jority  of  cases,  urethritis  arises  from  the  cause  last 
enumerated.  This  morbid  virus  induces  a  specific  in 
flammation  in  the  urethra,  of  so  troublesome  and  in 
veterate  a  character  as  often  to  baffle  all  the  remedial 
measures  of  the  most  skilful  and  experienced  medical 
men.  The  inflammation  is  supposed  by  some  to  be  of 
the  erysipelatous  kind,  and  generally  attacks  the 
lacunas  of  the  urethra. 

All  who  have  had  much  experience  in  this  disease, 
will  agree  with  me  that  it  is  one  of  the  most  intracta 
ble  with  which  we  have  to  deal :  Mackintosh  as 
sures  us  "  that  he  has  been  more  annoyed  and  dis 
gusted  in  conducting  the  treatment  of  gonorrhoea  than 
of  any  other  affection." 

We  are  at  present  in  ignorance  respecting  the 
primary  source  of  infectious  urethritis,  but  the  doctrine 
entertained  by  the  ancients,  and  so  strenuously  advo 
cated  by  John  Hunter,  and  his  cotemporaries,  in  regard 
to  the  identity  of  the  gonorrhoeal  and  syphilitic  virus, 
is  now  universally  abandoned.  The  disease  under 
consideration,  is  one  of  a  purely  local  character,  and  if 
left  to  itself,  under  favourable  circumstances,  will  ulti 
mately  terminate  in  spontaneous  recovery.  It  is  a 
matter  of  doubt  whether  ulcers  of  the  urethra  ever 
proceed  from  this  inflammation,  when  entirely  uncom 
plicated,  but  it  is  probable  that  the  few  cases  which 
have  been  reported  by  Sir  Astley  Cooper  and  others, 
in  which  the  malady  was  connected  with  ulcerations, 


AND  GENITAL  ORGANS.  467 

were  attributable  to  the  application  of  the  virus  of 
both  affections. 

We  have,  in  several  instances,  inoculated  individu 
als  with  the  matter  of  infectious  urethritis,  but  have 
never  been  able  to  produce  a  chancre  or  any  well- 
marked  constitutional  symptoms.  We  have,  in  one 
instance,  also  witne&sed  the  introc'u  ition  of  the  gonor- 
rhoaal  virus  into  the  blood,  but  without  giving  rise  to 
any  appreciable  effects.  While  on  the  other  hand,  it 
is  well  known,  that  if  syphilitic  virus  be  inoculated 
or  introduced  directly  into  the  mass  of  the  blood,  the 
symptoms  of  syphilis  speedily  result.  The  application 
of  gonorrhoeal  matter  to  the  eye,  gives  rise  to  a  very 
violent  and  dangerous  purulent  ophthalmia  ;  while  the 
application  of  syphilitic  virus  to  this  organ,  causes  an 
ulcer  generally  circumscribed,  and  unaccompanied  by 
violent  or  dangerous  inflammation  of  the  surrounding 
parts.  The  application  of  the  former  to  the  anus, 
causes  inflammation,  with  augmented  secretion,  and 
change  in  its  character  from  mucus  to  pus  ;  the  ap 
plication  of  the  syphilitic  poison,  causes  chancre  and 
its  concomitants. 

Urethritis  is  often  suspended  during  attacks  of  acute 
disease,  but  it  invariably  reappears  again  after  the 
subsidence  of  the  febrile  symptoms. 

From  these  facts  it  may  be  fairly  inferred,  that 
gonorrhoeal  matter  contains  a  specific  morbid  principle, 
capable  of  producing  a  peculiar  inflammation  and  dis 
charge,  when  brought  in  contact  with  mucous  sur 
faces.  This  inflammation  and  discharge  present  a 
uniform  appearance  quite  unlike  what  occurs  in  leu- 
corrhoea,  in  several  particulars.  The  matter  of  the 
former  is  infectious,  while  that  of  the  latter  is  non-in 
fectious  ;  the  inflammation  of  the  former  is  of  the  erysip- 
elatous  kind,  while  the  condition  of  the  mucous  mem 
brane  in  the  latter  is  more  allied  to  relaxation  and 
debility  than  to  inflammation ;  the  former  can  only 
arise  from  the  contact  of  gonorrhoeal  matter  with  a 
mucous  surface,  while  the  latter  never  proceeds  from 
any  cause  of  this  kind,  but  from  constitutional  weak 
ness,  confinements,  excesses  in  venery,  want  of  exer 
cise,  and  other  debilitating  habits. 

We  may  also  infer,  from  what  has  been  observed, 


DISEASES    OF    THE    URINARY 

that  the  syphilitic  matter  likewise  contains  a  specific 
morbid  virus,  sui  generis,  and  only  capable  of  exciting 
chancre,  when  applied  to  abraded  or  delicate  surfaces. 
It  should  always  be  remembered,  that  every  morbid 
substance   capable   of  impressing  the  organism,  con 
tains  a  certain  specific  morbid  principle,  which  usually 
operates  in  a  definite  manner,  causing  a  uniform  train 
of  symptoms,  and  requiring  a  certain  specific  medicinal 
agent  to  effect  a  prompt  cure.     These  morbid  princi 
ples   only    exist   in   infinitesimal   quantities  in   their 
media,  and  on  this  account  we  are  unable  to  detect 
or  analyze  them,  but  we  ought  none  the  less  to  acknowl 
edge  their  presence,  appreciate  their  influence,  and  en 
deavour,  if  possible,  to  discover  their  specific  antidotes. 
Diagnosis. — The  ordinary   period   at  which  infec 
tious  urethritis  makes  its  appearance  after  an  impure 
connection,  is  from  two  to  four  days.     We  have  known 
it  to  commence  in   a  few  instances,  in  eight  or  ten 
hours  after  exposure,  and  we  have  likewise  occasion 
ally  observed  an  interval  of  six  weeks  to  elapse  before 
its  onset.     Some   constitutions  possess  the   power  of 
resisting  the  action  of  the  poison  to  such  a  degree  as 
to  constitute  an  almost  entire  exemption  from  the  dis 
ease.     Other  individuals  are  so  little  susceptible,  that 
if  pains  be  taken  to  urinate  and  perform  thorough  ablu 
tion   soon  after  the  sin,  no   ill    consequences  result. 
Others  again  are  so  highly  susceptible,   either  from 
natural  organization,  or  from  abuse  of  stimulants,  that 
almost  the   very   touch    of  a   contaminated  female 
speedily  communicates  the  inflammation. 

The  disease  commences  by  a  tingling  or  itching 
sensation  at  the  orifice  of  the  urethra,  which  is  noticed 
especially  when  urinating.  In  a  short  time,  the  lips  of 
the  urethra  become  red  and  swollen  ;  the  blood-vessels 
of  the  organ  distended  ;  the  inflammation  increases 
and  extends  up  the  passage  for  an  inch  or  two  ;  there 
is  a  burning  or  scalding  pain  on  passing  water ;  an 
increased  secretion  takes  place  from  the  part  aifected, 
at  first  of  a  mucous  character,  but  as  the  inflammation 
increases  presenting  a  purulent  appearance,  of  a  yel 
low  colour,  or  if  the  disease  is  violent,  green  and  sani- 
ous.  The  urine,  which  often  contains  some  thread 
like  substances,  arising  from  the  inflammatory  action, 


AND  GENITAL  ORGANS.  469 

flows  from  the  urethra  in  a  diminished,  spiral  or  di 
vided  stream. 

In  a,  first  attack,  the  inflammation  does  not  usually 
confine  itself  to  the  extremity  of  the  urethra,  but  ex 
tends  along  the  canal  to  the  prostate  gland,  and  even 
to  the  bladder  itself.  Not  unfrequently  it  attacks  the 
glans  penis  and  the  frsenum,  in  which  case  it  often 
occasions  an  effusion  between  the  foreskin  and  glans, 
and  phymosis.  « 

When  the  inflammation  is  intense,  and  extends  up 
as  far  as  the  neck  of  the  bladder,  there  is  a  frequent 
and  urgent  desire  to  urinate,  the  ardor  urince  becomes 
more  extensive  and  painful,  involuntary  and  painful 
erections  occur,  chiefly  during  the  night,  and  some 
times  cause  distressing  emissions  of  semen  ;  sympa 
thetic  irritation  is  communicated  to  the  perineum,  oc 
casioning  painful  sensations  when  evacuating  the 
bowels,  or  the  bladder  ;  there  is  more  or  less  inflam 
mation  and  effusion  of  lymph  into  the  corpora  spon- 
giosa,  giving  rise  to  those  adhesions  and  painful  con 
tractions  termed  chordee ;  the  glands  of  the  groin  be 
come  irritated  and  enlarged,  and  there  is  a  partial  or 
even  total  suppression  of  the  discharge,  in  which  lat 
ter  case  the  disease  is  termed  dry  urethritis,  or  the 
"  blenorrhagie  seche  "  of  the  French. 

In  old  sinners,  the  inflammation  is  quite  prone  to 
attack  the  prostate  gland,  and  give  rise  to  those  un 
pleasant  symptoms  which  we  have  enumerated  when 
alluding  to  affections  of  this  structure. 

As  we  have  before  remarked,  if  the  disease  be  left 
to  itself,  and  the  patient  is  strictly  prudent  and  tem 
perate,  a  spontaneous  recovery  will  eventually  take 
place  ;  but  from  improper  medical  treatment,  undue 
exposure,  or  excesses  of  different  kinds,  the  disease 
often  terminates  in  gleet,  strictures,  abscesses,  dis 
eased  prostate,  irritable  bladder,  hernia  humoralis, 
inflammation  of  the  testicle  and  epididymis,  or  bubo. 

The  acute  stage  of  urethritis,  under  ordinary  cir 
cumstances,  terminates  in  from  one  to  three  weeks, 
when,  if  suitable  remedies  have  been  employed,  the 
discharge  ceases,  and  the  parts  speedily  recover  their 
tone ;  but  in  the  majority  of  instances,  the  acute 


470  DISEASES    OF    THE   URINARY 

stage  runs  into  a  chronic  inflammation,  when  it  re 
ceives  the  name  of 

GLEET. 

In  this  stage  of  the  disorder,  the  painful  symptoms 
peculiar  to  the  first  period,  ardor  urince,  frequent  in 
clination  to  urinate,  chordee,  spasmodic  pains  in  the 
region  of  the  perineum,  and  the  heat  and  swelling  of 
the  penis,  subside,  and  we  observe  little  else  than  an 
increase  and  alteration  in  the  character  of  the  secre 
tion  from  the  urethra.  This  discharge,  which  during 
the  acute  symptoms  was  purulent,  and  of  a  yellow  or 
greenish  colour,  now  presents  a  light  mucous  appear 
ance,  sometimes  transparent  and  ropy.  The  charac 
ter  of  this  discharge,  however,  is  often  temporarily 
changed  again  to  a  purulent  matter  of  a  yellow  or 
even  green  colour,  sometimes  sanious,  from  over-ex 
ercise,  excesses  in  drinking  or  eating,  sexual  inter 
course,  and  exposure  to  protracted  heat  or  cold.  The 
discharge  of  a  simple  gleet  usually  proceeds  from 
the  lacunae  of  the  urethra.  Some  writers  have  pro 
mulgated  the  dangerous  doctrine,  that  the  matter  of  a 
gleet  is  not  infectious  ;  but  this  is  an  error,  for  we  have 
known  many  well  authenticated  instances  where 
virulent  urethritis  has  arisen  from  the  application  of 
gleety  matter. 

When  a  gleet  has  been  permitted  to  continue  for  a 
long  time,  and  particularly  if  the  case  has  been  inju 
diciously  treated  by  inordinate  doses  of  copaibae,  cu- 
bebs,  turpentine,  and  the  endless  train  of  irritating 
injections,  there  often  supervenes  a 

STRICTURE    OF    THE    URETHRA. 

A  stricture  may  occur  during  the  height  of  acute 
urethritis,  from  tumefaction  of  the  mucous  membrane 
of  the  canal,  or  from  the  irritation  caused  by  improper 
or  unskilful  introduction  of  bougies,  and  by  strong 
injections.  The  obstruction  in  some  cases  of  this 
description  is  so  complete,  that  very  painful  reten 
tions  of  urine,  with  its  accompanying  symptoms,  su 
pervene,  requiring  the  most  prompt  remedial  mea 
sures  in  order  to  ward  off  the  necessity  of  puncturing 
the  bladder.  This  variety  of  stricture  may  be  re- 


AND  GENITAL  ORGANS.  471 

moved  in  a  short  time  by  proper  medicines,  without 
the  aid  of  a  surgeon. 

There  is  a  second  variety  of  stricture  not  necessa 
rily  connected  with  infectious  urethritis,  termed  spas 
modic  stricture.  The  disease  consists  in  a  sudden 
spasmodic  contraction  of  some  portion  of  the  urinary 
canal,  which  impedes  the  flow  of  urine,  and  sometimes 
causes  a  partial  retention.  These  spasmodic  contrac 
tions  may  arise  from  mechanical  injuries,  diseased 
prostate,  or  stimulating  diuretics,  but  they  are  for  the 
most  part  connected  with  permanent  stricture. 

The  third  variety  of  stricture,  which  is  by  far  the 
most  common  and  serious,  is  termed  the  permanent 
stricture.  Its  approach  is  so  gradual  and  impercepti 
ble,  that  individuals  rarely  suspect  anything  of  the 
kind,  until  it  has  made  considerable  progress.  The 
disease  arises  from  a  gradual  thickening  of  the  mu 
cous  membrane  of  the  urethra,  from  badly  treated  or 
long  continued  inflammation. 

The  first  symptoms  observable  in  this  stricture  are, 
a  sensation  after  urinating  as  if  a  few  drops  remained 
behind ;  stream  diminished  in  size,  and  issuing  from 
the  urethra  in  a  spiral  form,  or  split  in  several  parts  ; 
straining  to  pass  the  water  more  rapidly  through  the 
obstructed  canal ;  aggravation  of  all  the  symptoms 
on  wetting  the  feet,  taking  cold,  over-exercise,  fatigue, 
and  venereal  excesses.  In  this  stricture,  there  is 
always  more  or  less  discharge  of  a  ropy  kind  of  mu 
cus,  which  is  often  temporarily  changed  by  excesses, 
into  a  purulent  or  bloody  matter.  This  complaint  is 
quite  apt  to  induce  inguinal  hernia,  from  the  straining 
efforts  employed  in  urinating. 

It  is  probable  that  two-thirds  of  the  cases  treated 
as  simple  gleets,  and  which  so  frequently  baffle  the 
physician,  are,  in  reality,  dependent  solely  on  this 
kind  of  stricture. 

In  bad  cases  of  permanent  stricture,  the  urine  is 
passed  drop  by  drop,  the  distention  and  pain  in  the 
region  of  the  bladder  become  very  severe,  much  con 
stitutional  irritation  occurs,  and  the  patient  is  unable 
to  rest  day  or  night.  Whenever  this  state  of  things 
obtains,  immediate  recourse  should  be  had  to  bougies. 

The  removal  of  a  permanent  stricture  can  only  be 


472  DISEASES    OF    THE    URINARY 

accomplished  by  means  of  the  knife,  or  the  applica 
tion  of  caustic,  or  by  gradual  dilation  by  means  of 
bougies.  The  cure  by  the  latter  means  is,  at  the  pre 
sent  time,  almost  universally  recommended. 

Almost  all  strictures  are  located  far  up  the  canal  of 
the  urethra,  behind  its  bulb,  but  they  may  occur  near 
the  extremity  of  the  penis,  or  three,  four,  or  five  inches 
above  this  point. 

An  occasional  consequence  of  stricture  is, 

FISTULA    IN    PERINEO. 

When  the  contraction  is  so  great  as  to  cause  con 
siderable  obstruction  to  the  passage  of  the  urine,  this 
fluid  is  forced  by  the  frequent  and  violent  efforts  at 
expulsion,  into  the  parts  back  of  the  stricture,  in  such 
a  manner  as  to  form  a  kind  of  cul  de  sac,  which,  from 
constant  distention,  eventually  ulcerates  an  opening 
externally,  and  a  perineal  fistula  is  formed. 

Abscesses  also  arise  sometimes  from  inflammation 
and  tumefaction  of  the  lymphatic  glands  in  other 
parts  of  the  urethra.  These  little  swellings  may 
open  into  the  urethra,  or  discharge  themselves  exter 
nally.  The  most  common  seat  of  these  abscesses  is 
near  the  freenum,  or  opposite  the  scrotum. 

DISEASED    PROSTATE, 

May  also  be  ranked  amongst  the  occasional  conse 
quences  of  repeated  attacks  of  urethritis.  During  the 
continuance  of  the  latter  affection,  not  only  the 
urethra,  but  the  prostate,  the  bladder,  and  the  tes 
ticles,  receive  an  unusual  supply  of  blood,  in  conse 
quence  of  which  they  become  irritated,  and  often  en 
larged,  from  depositions  of  coagulable  lymph.  This 
condition  of  things  may  exist  without  attracting  much 
attention  until  the  individual  is  advanced  in  years, 
when  a  scirrhous  degeneration,  or  an  abscess,  is  ex 
ceedingly  apt  to  result.  Either  lobe  of  the  prostate 
may  become  enlarged  separately,  or  the  whole  three 
may  be  involved  ;  but  the  most  troublesome  symptoms 
arise  from  an  enlargement  of  the  middle  lobe,  on  ac 
count  of  its  proximity  to  the  orifice  of  the  urinary 
canal. 

Sir  Astley  Cooper  was  of  opinion,  that  enlargement 


AND  GENITAL  ORGANS.  473 

of  this  gland  is  attributable  to  advanced  age,  rather 
than  disease  ;  but  from  the  fact,  that  persons  who 
have  been  afflicted  in  this  manner  have  almost  inva 
riably  been  subject  to  repeated  venereal  attacks  in 
early  life,  we  may  fairly  infer,  that  a  predisposition  is 
always  established  in  the  structure,  which  renders  it 
liable  to  take  on  diseased  action  when  the  powers  of 
the  organism  have  become  impaired  by  age. 

Enlargement  of  the  lateral  lobes  of  the  prostate 
may  be  readily  detected  by  introducing  the  finger  into 
the  rectum.  The  middle  lobe  may  always  be  felt  by 
the  catheter  when  much  enlarged,  and  it  will  gene 
rally  be  found  exceedingly  difficult  to  pass  it  by  the 
gland  into  the  bladder.  By  directing  the  point  of  the 
instrument,  (which  should  be  of  medium  size,)  slightly 
upwards,  and  depressing  the  handle  at  the  proper 
time,  the  object  may  usually  be  accomplished.  But 
of  all  others,  these  cases  require  great  delicacy  of 
touch  and  practical  tact,  to  enable  the  operator  to 
succeed  facilely,  and  without  doing  injury  to  the 
irritated  parts. 

Diseases  of  the  prostate  are  quite  liable  to  become 
aggravated  by  over-exertion,  riding,  acrid  urine,  expo 
sure  to  wet  and  cold,  and  stimulating  drinks. 

Another  exceedingly  unpleasant  consequence  of 
neglected  or  badly  treated  urethritis,  is  the  disease 
termed 

IRRITABLE    BLADDER. 

This  affection  arises  from  long  continued  inflamma- 
tion,which  in  the  end  so  impairs  the  function  of  the  blad 
der,  that  the  presence  of  a  very  small  quantity  of  urine 
forces  it  to  contract,  and  thus  forms  an  incontinence 
of  urine.  Although  this  condition  of  the  bladder  may 
arise  from  numerous  causes  which  have  already  been 
enumerated,  it  not  unfrequently  proceeds  from  exten 
sion  of  urethritic  inflammation  to  this  organ,  and 
from  protracted  use  of  diuretics.  The  malady  is 
readily  distinguished  from  stone,  by  the  relief  which 
always  follows  the  evacuation  of  the  bladder,  while 
this  operation  aggravates  the  painful  sensations  in 
the  latter  affection. 

This  disease  generally  baffles  all  the  resources  of 


474  DISEASES    OF    THE    URINARY 

allopathy,  but  we  take  pleasure  in  appealing  to  the 
philosophic  practice  whether  the  same  remark  is  just 
with  reference  to  homoeopathy. 

The  next  malady  to  which  we  shall  allude  in  con 
nection  with  urethritis,  is 

HERNIA    HUMORALIS. 

During  the  acute  stage  of  urethritis,  the  inflamma 
tion  sometimes  extends  even  to  the  spermatic  chord, 
the  epididymis,  and  the  testicle.  This  is  very  apt  to 
occur  when  the  discharge  is  suddenly  arrested  by  ir 
ritating  injections,  especially  when  the  inflammation 
pervades  the  whole  extent  of  the  canal.  When  the 
substance  of  the  testicle  becomes  involved,  the  pain 
is  very  severe,  and  febrile  symptoms  more  or  less 
grave,  set  in.  This  inflammation  may  terminate  in 
resolution,  suppuration,  or  chronic  enlargement  and 
induration.  In  those  instances  where  suppuration 
occurs,  the  abscesses  usually  break  externally,  and 
form  fistulous  passages  which  are  difficult  to  cure,  on 
account  of  the  continual  irritation  kept  up  by  the  se 
cretion  of  semen,  a  portion  of  which  is  constantly 
being  discharged  through  these  ulcerated  openings. 

Chronic  enlargements  of  the  testicles  should  com 
mand  our  early  attention,  on  account  of  their  strong 
tendency  to  terminate  in  scirrhous  degenerations. 

In  urethritis,  and  other  affections  of  the  urino-geni- 
tal  apparatus,  the  prudent  physician  will  always  ad 
vise  the  use  of  the  suspensory  bandage,  as  a  precau 
tionary  measure. 

When  the  urethritis  is  so  severe  as  to  affect  the 
lymphatic  glands  of  the  penis,  the  disease  may  be 
propagated  to  several  of  the  glands  of  the  groin, 
when  we  have  a 

BUBO. 

These  buboes  are  called  sympathetic?  in  contradis 
tinction  to  those  which  proceed  from  syphilitic  infec 
tion.  The  frequent  occurrence  of  such  tumours 
during  the  course  of  urethritis,  probably  first  led 
medical  men  to  confound  this  disease  with  syphilis.  But, 
on  close  examination,  the  sympathetic  bubo  will  be 


AND    GENITAL    ORGANS.  475 

found  to  be  composed  of  several  enlarged  glands,  while 
that  of  syphilis  is  an  enlargement  of  a  single  gland. 

The  sympathetic  bubo  is  not  usually  attended  with 
great  pain,  nor  does  it  run  on  to  suppuration,  unless 
the  patient  is  decidedly  scrofulous ;  while  syphilitic 
bubo  is  attended  with  much  inflammation  and  pain, 
and  is  very  prone  to  advance  to  the  suppurative  stage. 
A  very  large  majority  of  sympathetic  buboes  subside 
spontaneously,  and  require  no  medicinal  treatment. 

In  females,  all  of  the  symptoms  of  the  disease  are 
lighter  than  in  the  male  sex.  Indeed,  the  similarity 
between  this  affection  and  leucorrlic&a  is  so  great,  that 
it  is  sometimes  a  matter  of  great  difficulty  to  distin 
guish  them. 

Mr.  Travers  asserts,  that  the  urethra  itself  is  rarely 
affected  in  females,  but  that  the  inflammation  attacks 
the  clitoris,  the  inferior  commissure  of  the  labia  and 
rapha,  the  nymphae,  and  the  parts  (Cowper's  glands) 
around  the  orifice  of  the  urethra. 

In  the  worst  form  of  the  complaint,  as  it  occurs  in 
women,  the  labia,  the  nymphae,  and  the  clitoris,  be 
come  swollen  and  painful,  the  inflammation  extends 
to  the  womb  and  bladder,  and  there  will  be  frequent 
inclination  to  urinate,  severe  scalding  by  the  water, 
and  a  purulent,  irritating  discharge.  But  all  of  these 
symptoms  are  often  met  with  in  inflammatory  leucor- 
rho3a,  and  the  discharge  itself  even  acquires  so  acrid 
a  character  as  to  become  capable  of  propagating  a 
similar  discharge  by  contact  with  the  male  organ. 
We  have,  in  more  than  one  instance,  been  consulted 
by  parties  of  the  highest  respectability,  in  relation  to 
purulent  discharges,  and  scalding  of  the  urine,  which 
have  been  contracted  from  the  wife,  but  by  explaining 
the  circumstance  just  alluded  to,  have  been  able  to 
dissipate  the  most  unjust  suspicions,  and  to  restore 
confidence  and  harmony  which  must  have  been  utterly 
destroyed  without  such  explanation. 

The  following  are  the  surest  diagnostic  marks,  with 
which  we  are  acquainted,  between  the  two  diseases  : 
Ieucorrho3a  is  gradual  in  its  progress,  and  may  be 
generally  traced  to  constitutional  debility,  or  to  diffi 
cult  and  protracted  labours,  or  mechanical  injuries 
during  accouchement.  It  is  usually  accompanied  also 


476  DISEASES    OF    THE    URINARY 

by  prolapsus  uteri,  or  dragging  pain,  or  tired  feel 
ing  in  the  left  side,  bearing  down  pains,  and  general 
feelings  of  relaxation  and  debility. 

Gonorrhoeal  inflammation  is  sudden  and  rapid  in 
its  approach,  and  attacks  individuals  in  the  soundest 
health  :  the  symptoms  acquire  their  greatest  severity 
in  one  or  two  weeks,  and  the  discharge  causes  a  deep- 
coloured  (yellow  or  greenish)  stain  upon  the  linen, 
surrounded  by  a  palish  yellow  border. 

A  careful  attention  to  the  history  of  each  individual 
case,  will  aid  us  materially  in  forming  a  correct  diag 
nosis. 

Therapeutics. — Infectious  urethritis  is  at  the  present 
time  almost  universally  looked  upon  as  a  purely  local 
disease, — confined  in  its  first  stages  to  a  small  portion 
of  the  mucous  membrane  of  the  urethra.  It  is  true 
that  the  inflammation  often  extends  up  the  urinary 
canal  to  the  prostate  gland,  and  to  the  bladder  ;  but 
it  is  highly  probable  that  these  secondary  symptoms 
are  owing  to  bad  treatment,  or  imprudence  on  the 
part  of  patients,  rather  than  to  the  natural  and  legiti 
mate  tendency  of  the  malady.  We  adopt  this  opinion 
from  having  often  observed  spontaneous  cures  occur 
in  six  or  eight  weeks  without  medicine  of  any  kind, 
and  without  any  structure  but  the  urethra  becoming 
affected, — the  patients  having  simply  placed  them 
selves  under  a  rigid  dietetic  regimen. 

It  may  be  questioned  whether  any  internal  remedy 
is  now  known,  which  can  be  considered  a  true  and 
certain  specific  for  the  cure  of  this  local  inflammation. 
Many  medicines  have  been  brought  forward  by  both 
schools  as  worthy  of  our  entire  confidence,  but  not  one 
of  them  has  yet  stood  the  test  of  practical  experiment, 
— not  one  has  been  able  to  control  the  symptoms,  or 
remove  the  complaint  with  any  degree  of  certainty. 
On  the  contrary,  many  of  them  have  repeatedly  been 
observed  to  aggravate  the  inflammation,  causing  it  to 
extend  to  the  neighbouring  structures,  and  thus  se 
riously  to  complicate  this  naturally  simple  disease. 

The  ordinary  plan  of  treatment,  according  to  the 
old-school  method,  is  in  ihejirst  stage  to  bleed,  leech, 
foment,  physic  with  mercurials,  or  the  neutral  salts, 
and  to  nauseate,  sweat,  and  prostrate  the  system  with 


AND  GENITAL  ORGANS.  477 

antimonials.  In  other  words,  it  is  deemed  necessary 
to  punish  the  whole  organism ; — to  inflame  the  bowels 
with  cathartics, — to  impair  the  tone  of  the  stomach 
by  nauseating  doses  of  antimony, — to  debilitate  the 
capillaries  by  profuse  sweats, — to  abstract  the  life- 
giving  principle  from  the  veins, — and  to  reduce  the 
patient  to  a  state  of  prostration  and  positive  illness, 
in  order  to  reach  a  little  circumscribed  inflammation 
in  the  urethra  !  After  the  patient  has  been  reduced 
secundem  artem,  the  custom  is  then  to  administer  enor 
mous  doses  of  balsam  copaibce,  cubebs,  turpentine,  lyttce, 
iodine,  and  nitre,  internally,  and  to  make  use  of  stimu 
lating  injections  of  zinc,  lead,  copper,  mercury,  nitrate 
of  silver,  oil  of  vitriol,  chloride  of  lime,  and  diluted 
sulphuric  acid,  ad  libitum.  Balsam  copaibce  is  the 
medicine  employed  in  most  instances,  and  as  it  oper 
ates  specifically  upon  the  stomach  and  the  respiratory 
organs,  we  often  observe  the  most  serious  affections 
of  these  organs  arise  in  consequence  of  its  free  and 
protracted  use.  Who  that  has  made  use  of  this  remedy 
to  any  great  extent,  has  not  witnessed  the  occurrence 
of  troublesome  dyspeptic  symptoms,  of  haemoptysis,  of 
cough,  and  other  indications  of  dangerous  pulmonary 
disorder,  from  it  ? 

Cases  however  occur,  in  which  the  symptoms  of 
urethritis  cease  under  the  use  of  this,  and  the  other 
diuretics  alluded  to,  but  such  instances  are  rare,  and 
the  remark  of  the  celebrated  Dr.  Forbes  respecting 
allopathic  remedies  in  general,  will  hold  good  here, 
viz. :  that  "  the  patient  gets  well  in  spite  of  the  doc 
tor." 

We  shall  not  discuss  the  propriety  of  the  antiphlo 
gistic  course  adopted  during  the  acute  stage,  for  we 
believe  that  all  whose  prejudices  will  permit  them  to 
exercise  that  admirable  requisite,  common  sense,  will 
perceive  at  a  glance  the  folly  of  tormenting  and  pros 
trating  the  whole  body  for  the  sake  of  acting  upon  a 
simple  local  inflammation,  which,  when  left  to  itself, 
never  terminates  in  ulceration  or  disorganization  of 
the  tissue  affected,  but  in  spontaneous  recovery. 

And  what  shall  we  say  of  the  homoeopathic  reme 
dies  which  are  usually  employed  in  the  treatment  of 
this  complaint  ?  Why,  simply  that  the  true  specific 


478  DISEASES    OF    THE    URINARY 

has  not  yet  been  discovered.  We  have  tested  these 
medicines  in  numerous  instances,  both  the  high  and 
low  attenuations,  and  we  regret  to  announce  as  the 
result  of  our  observations,  that  they  have  proved  but 
little  more  successful  than  the  pernicious  applications 
of  the  old  school. 

We  are  quite  aware  that  it  is  much  easier  to  find 
fault  with  prevailing  methods  of  practice,  than  to  pro 
pose  and  introduce  better  new  ones.  But  if  we  suc 
ceed  in  attracting  the  attention  of  physicians  more 
particularly  to  the  subject,  and  putting  them  on  the 
qui  vive  to  find  out  a  positive  specific,  our  object  will 
be  accomplished.  In  the  mean  time  we  shall  point 
out  the  course  of  treatment  which  we  have  found  most 
successful  in  the  different  stages  of  the  malady. 

For  therapeutical  purposes  the  disease  may  be 
classified  as  follows : 

First.  The  preventive  period, — or  that  which  inter 
venes  between  the  exposure  and  the  first  symptoms  of 
the  malady.  The  average  duration  of  this  period  is 
about  three  days. 

Second.  The  forming  stage, — or  the  period  which 
elapses  from  the  commencement  of  the  prickling,  tin 
gling,  or  itching  sensation,  with  slight  redness  and 
swelling  of  the  lips  of  the  urethra,  and  a  slight  oozing 
of  mucus  or  limpid  matter,  up  to  the  period  when  the 
inflammation  has  extended  to  the  fossa  navicularis,  and 
become  strongly  pronounced,  with  a  purulent  dis 
charge  of  a  yellow  or  greenish  colour.  This  stage 
usually  lasts  from  twelve  to  forty-eight  hours. 

Third.  The  acute  or  inflammatory  stage, — including 
the  period  which  commences  at  the  termination  of  the 
last  stage,  and  the  subsidence  of  the  ardor  urince,  the 
acute  inflammation  of  the  urethra,  the  swelling  and 
tenderness  of  the  penis,  and  the  change  of  the  yellow 
or  greenish  secretion,  to  one  of  a  light  transparent  and 
ropy,  or  a  muco-purulent  character.  The  natural  du 
ration  of  this  stage,  when  proper  restrictions  are  used 
as  to  diet,  stimulants,  and  exercise,  is  from  one  to  two 
weeks. 

Fourth.  The  chronic  stage,  or  that  form  of  the  ma 
lady  termed  gleet. 

Now,  as  our  object,  in  accordance  with  the  homce- 


AND  GENITAL  ORGANS.  479 

pathic  doctrine  of  cure,  is  to  produce  in  the  tissue  mor 
bidly  affected,  a  new  and  healthy  medicinal  action, 
which  shall  supersede  the  morbid  inflammation,  we 
apply  our  remedies  directly  to  the  diseased  part, 
instead  of  bringing  them  in  contact  with  it  through 
the  stomach,  blood,  and  kidneys.  The  malady  is  not 
constitutional, — there  is  no  other  structure  of  the 
economy  affected,  or  upon  which  we  wish  to  act, — but 
our  sole  object  is  to  prevent  or  to  remove  a  simple 
local  inflammation. 

Our  remedies  then,  during  the  first  or  preventive 
period,  are  the  occasional  injections  into  the  urethra, 
of  a  solution  of  nitrate  of  silver,  (in  the  proportion  of 
two  or  three  grains  to  the  ounce  of  distilled  water.)  or  of 
sulphate  of  zinc,  in  the  proportion  of  four  grains  to  the 
ounce  of  water.  The  occasional  use  of  these  injections 
after  an  impure  coition,  with  strict  temperance  and 
quiet,  will  usually  prevent  the  occurrence  of  the  dis 
ease.  These  remedies  neutralize  the  absorbed  virus 
before  it  has  time  to  impair  the  function  of  the  mem 
brane  with  which  it  is  in  contact,  and  thus  its  power 
to  do  injury  is  summarily  destroyed. 

There  is  also  a  certain  and  speedy  cure  for  the  se 
cond  or  forming  stage.  The  symptoms  of  this  stage, 
as  we  have  seen,  are  a  tingling  or  itching  at  the  end 
of  the  urethra,  with  a  slight  redness,  and  a  slightly  in 
creased  secretion  of  mucus.  The  remedy  for  this  stage, 
is  a  saturated  solution  of  nitrate  of  silver,  a  small  quan 
tity  of  which  is  to  be  applied,  by  means  of  a  small 
glass  syringe,  or  by  a  small  bit  of  sponge,  to  the  ure 
thra  for  an  inch  in  extent.  The  solution  should  be  de 
licately  and  rapidly  applied,  and  a  quantity  used  just 
sufficient  to  give  the  portion  of  the  membrane  touched, 
a  white  cast.  This  causes  a  smart  but  healthy  medi 
cinal  inflammation  which  subsides  in  about  24  hours, 
leaving  the  structure  cured.  This  course  is  strictly 
homoeopathic,  for  we  impress  directly  the  tissue  affect 
ed,  produce  a  powerful  medicinal  aggravation  of  the 
symptoms,  and  overwhelm  the  disease  by  substi 
tuting  temporarily,  another  inflammatory  action.  No 
unpleasant  consequences  ever  result  from  the  use  of 
this  remedy,  when  it  is  employed  before  the  com 
mencement  of  the  third  or  acute  stage.  Our  experience 


480  DISEASES    OF    THE    URINARY 

with  this  solution  has  been  extensive,  and  we  there 
fore  confidently  recommend  it  as  a  perfectly  safe  and 
sure  remedy  in  this  stage  of  the  complaint. 

During  the  third  or  acute  stage,  it  is  a  question  whe 
ther  any  remedies,  either  general  or  topical,  can  be 
employed  with  any  material  advantage,  with  the  ex 
ception  of  the  internal  use  of  aconite,  which  may  be 
given  to  shorten  the  inflammatory  stage.  This  medi 
cine  is  particulary  applicable  when  febrile  symptoms 
are  present.  Throughout  this  stage,  the  patient  should 
be  restricted  to  the  most  rigid  vegetable  or  farina 
ceous  diet,  to  cold  water,  and  prohibited  from  taking 
much  exercise.  Ablutions  with  cold  water,  should  be 
often  employed,  in  order  to  keep  the  parts  as  free  as 
possible  from  the  irritating  discharge.  After  the  ur 
gent  symptoms  have  subsided  under  the  use  of  aconite, 
and  the  other  means  we  have  just  pointed  out,  and 
the  fourth  or  chronic  stage  has  commenced,  we  may  re 
sort  to  injections  composed  of  one  grain  of  sulphate  of 
zinci  to  I  viii.  of  water.  These  injections,  in  order  to 
be  efficient,  must  be  repeated  every  half-hour  during 
the  day,  until  the  discharge  ceases.  It  will  be  of  no 
service  to  use  this  solution  three  or  four  times  in  the 
day,  for  the  chief  object  is  to  wash  out  the  urethra  as 
fast  as  the  matter  forms,  and  thus  prevent  the  constant 
reabsorption  which  would  otherwise  take  place. 

The  principal  reason  why  urethritis  is  so  difficult  to 
cure,  when  once  fully  established,  is,  that  the  matter 
itself  being  infectious,  and  liable  to  be  constantly  re- 
absorbed,  thus  operates  as  a  continual  exciting  cause. 
If  at  any  given  instant  the  whole  urethra  could  be 
restored  to  perfect  health,  a  single  drop  of  the  morbid 
secretion  which  it  had  been  pouring  out,  applied  to 
the  part,  would  be  sufficient  to  re-excite  the  disease  in 
all  its  violence.  It  is  evident,  then,  that  the  discharge 
must  be  arrested  abruptly  by  the  remedy  employed,  or 
we  must  use  our  injections  sufficiently  often  to  dilute 
and  remove  the  virus  as  fast  as  formed,  and  at  the  same 
time  to  change  the  morbid  action  of  the  membrane  to  a 
healthy  medicinal  action. 

In  regard  to  the  plan  of  making  an  application  to 
the  urethra,  of  a  medicine  so  powerful  as  to  arrest  the 
discharge  suddenly,  like  the  solution  mentioned  under 


AND    GENITAL    ORGANS.  481 

our  second  head,  it  is  attended  in  this  stage  of  the  af 
fection  with  many  dangers.  The  canal  of  the  urethra 
is  generally  affected  so  high  up  as  to  render  the  cer 
tain  application  of  this  or  any  other  sufficiently  power 
ful  solution  entirely  impracticable. 

But  the  other  method,  to  which  we  have  alluded,  is 
one  of  entire  feasibility  and  safety,  and  is  for  the  most 
part  attended  with  success,  when  the  discharge  is  en 
tirely  unconnected  with  a  stricture.  It  is  proper  to 
observe  that,  in  all  cases,  the  patient  should  urinate 
previous  to  the  use  of-  injections.  Another  injection 
which  we  have  sometimes  used  with  marked  success 
in  this  stage,  is  a  mixture  of  calomel  and  olive  oil,  in 
the  proportion  of  a  drachm  to  the  ounce,  once  or  twice 
a  day,  until  the  cessation  of  the  diseased  action. 

If,  however,  notwithstanding  the  thorough  and  per 
severing  employment  of  the  zinc  solution  and  the  mix 
ture  of  calomel  and  oil,  the  discharge  still  continues, 
recourse  should  be  had  to  the  introduction  of  bougies, 
either  plain  or  smeared  with  a  cerate  containing  a 
sufficient  quantity  of  pulverized  nitrate  of  silver.  These 
should  be  carefully  introduced  two  or  three  times  a 
week,  until  we  have  stimulated  the  diseased  mem 
brane  to  a  natural  and  healthy  action. 

The  above  plan  of  treatment,  we  believe  to  be  more 
efficient,  safe,  and  consonant  with  the  true  princi 
ple  of  cure,  than  any  other  which  has  yet  been 
promulgated  :  yet,  we  do  not  claim  for  it  infallibility. 
We  can  only  assure  our  readers  that  we  have  tho 
roughly  tested  every  theory  and  process  which  has  been 
proposed  by  either  school,  and  that  after  all  of  this 
practical  experience,  we  have  presented  them  with 
what  we  deem  the  best  method  of  treatment  in  this 
disgusting  malady. 

For  the  information  of  those  who  desire  to  make  use 
of  internal  remedies  either  alone  or  in  combination 
with  injections,  we  name  the  following  medicines  as 
the  best  with  which  we  are  at  present  acquainted : 
cannabis,  cantharides,  lussilago  pcrtus.,  cubebce,  mercu- 
rius  sol.,pctroselinum,  aconite,  acid  nit.,  sepia,  terebinth., 
copaiba,  pulsatilla,  nux  vomica,  sulphur,  ferrum. 

The  remedies  which  should  be  consulted  in  irritable 
bladder,  are,  cantharidcs.  cannabis,  lycopodium,  mercu- 
21 


482  DISEASES    OF    THE    URINARY 

rius,  uva  ursa,  terebinthina,  pulsatilla,  copaiba,  cubebce, 
sulphur,  iodine,  and  camphor. 

Inflammation  of  the  testicles  and  epydidimis  : — 

Our  first  care  in  this  complaint,  should  be  to  suspend* 
the  inflamed  organ  by  means  of  a  suitable  apparatus, 
in  such  a  manner  as  to  afford  complete  support  in  all 
positions,  and  thus  prevent  the  enlarged  gland  from 
dragging  upon  the  spermatic  chord.  The  recumbent 
posture  should  be  strictly  enjoined,  and  we  should 
have  constantly  applied  to  the  parts,  cloths  wet  with 
cold  water.  As  soon  as  the  cloths  are  warmed  by 
contact  with  the  inflamed  testicle,  they  should  be  again 
dipped  and  reapplied  until  the  heat  and  inflammation 
have  disappeared. 

If  the  disease  has  arisen  from  sudden  suppression  of 
urethritis,  or  from  the  use  of  powerful  injections  during 
the  acute  stage,  we  may  give  mercurius,  aconite,  nux 
vomica,  spongia,  clematis,  or  iodine. ' 

When  it  has  been  caused  by  the  injudicious  intro 
duction  of  bougies,  arnica,  aconite,  and  pulsatilla,  will 
be  found  applicable. 

In  cases  where  the  inflammation  has  degenerated 
into  a  chronic  induration  of  the  testicles,  our  best  reme 
dies  are,  aurum,  acid  nitric,  rhododendron,  sulphur,  mer 
curius,  spigelia,  iodine,  and  cicuta. 

SECTION    IX. 

SYPHILIS. 

Much  discussion  has  taken  place  respecting  the  first 
introduction  of  this  disease  into  Europe.  Some  main 
tain  that  the  followers  of  Columbus  brought  it  with 
them  from  America  ;  others  that  it  was  communicated 
by  the  Spaniards  to  the  French,  during  the  siege  of 
Naples,  by  Charles  VIII.,  in  1495.  It  appears,  how 
ever,  that  occasional  allusion  is  made  in  different  parts 
of  the  scriptures,  to  a  disease  of  the  sexual  organs, 
capable  of  being  propagated  by  coition,  contact,  &c. 
In  Leviticus,  Moses  mentions  such  an  affection,  and 
speaks  of  those  afflicted  as  being  polluted  and  unfit 
to  associate  with  the  healthy.  David  also  describes 
one  variety  of  syphilis  in  the  thirty- fourth  psalm.  He- 
roditus,  too,  speaks  of  an  affection  of  the  sexual  organs 


AND  GENITAL  ORGANS.  483 

which  the  Scythians  contracted  from  the  women  with 
whom  they  had  connection,  after  profaning  the  temple 
of  Venus  Urania.  Later  writers,  Salicetus,  Gordoneus, 
and  Valereus,  who  flourished  about  the  year  1250,  al 
lude  to  an  infectious  disorder  of  the  genitals,  proceed 
ing  from  the  copulation  of  men  writh  unclean  prosti 
tutes.  Many  reputable  authors  have  entertained  the 
opinion  that  the  ancient  leprosy  was  nothing  more  than 
syphilis,  renderedjsevere  by  exposure,  hardship,  insuf 
ficient  nourishment,  and  improper  medical  treatment. 
But  an  objection  has  been  urged  against  this  view,  from 
the  supposition  that  leprosy  could  be  communicated 
by  contact  with  an  infected  person, — by  drinking  from 
the  same  cup,  by  inhaling  his  breath,  or  even  sitting 
at  the  same  table  with  him.  It  is  no  less  true  that  sy 
philis  occasionally  presents  a  character  equally  viru 
lent  and  diffusible.  During  a  great  portion  of  the  six 
teenth  century,  it  was  so  contagious  in  some  parts  of 
Europe,  that  it  was  communicated  by  lying  in  the 
same  bed,  by  the  clothes,  gloves,  money,  or  breath  of 
the  patient.  A  variety  of  syphilis  also  prevailed  in 
Canada  some  years  ago.  of  so  virulent  a  nature,  that  it 
was  communicated  by  the  breath,  and  by  contact. 

We  fully  concur  with  Dr.  Thompson,  who  "thinks  it 
probable  that  the  disease  has  existed,  more  or  less,  and 
under  different  grades  of  severity,  in  all  ages,  and  that 
it  has  been  thousands  of  times  generated  de  novo  by 
impure  sexual  intercourse." 

The  causes  which  may  have  conduced  to  vary  its 
character  at  different  periods,  are  numerous ;  and  we 
suggest  the  following  as  a  few  of  them. 

It  has  been  observed  that  exposure  of  the  body  to 
a  cold,  humid  atmosphere,  excessive  fatigue,  changes 
of  diet  and  of  climate,  unwholesome  food  and  ne 
glect  of  cleanliness,  favour  the  rapid  progress  and 
destructiveness  of  the  malady;  while  a  dry,  warm  and 
equable  temperature,  cleanliness,  nutritious  food,  and 
comfortable  lodgings,  are  circumstances  which  con 
duce  to  render  it  comparatively  mild.  These  facts 
go  far  to  explain  the  reason  of  its  great  violence 
amongst  those  ancient  tribes  who  were  accustom 
ed  to  dwell  in  tents,  and  to  move  about  from  place 
to  place  ;  and  who  were  so  negligent  in  their  habits  of 


484  DISEASES  OF  THE  URINARY 

living,  their  food  and  their  persons,  that  Moses 
deemed  it  necessary  to  make  rigid  laws  in  regard  to 
the  selection  of  food  and  the  habit  of  personal  ablu 
tions.  When  we  reflect  that  persons  who  were  sup 
posed  to  be  leprous,  were  immediately  driven  out  of 
the  camp  —  away  from  all  intercourse  with  the 
healthy — and  thus  forced  to  undergo  every  exposure 
in  respect  to  raiment,  shelter  and  food,  we  cannot  be 
surprised  that  the  disease,  supposing  it  to  have  been 
syphilis,  should  so  often  have  assumed  a  frightful 
.aspect. 

Its  violence  during  the  siege  of  Naples  in  1495, 
may  also  be  explained,  when  we  bear  in  mind  the 
forced  marches,  the  changes  of  climate  and  of  diet, 
and  the  constant  excitement  and  fatigue  to  which  the 
soldiers  were  exposed.  The  same  severity  marked 
its  prevalence  in  the  British  army  in  Portugal,  while 
the  natives  themselves  were  but  slightly  affected,  al 
though  exposed  to  similar  contamination. 

One  of  our  army  surgeons  recently  informed  me 
that  the  same  difficulty  was  experienced  among  our 
soldiers  during  the  Mexican  campaign  in  1847  and 
1848 :  they  contracted  the  disorder,  while  the  Mexi 
cans  experienced  but  slight  inconvenience,  although 
exposed  to  the  same  virus.  The  argument  also  holds 
good  with  respect  to  sailors  who  are  so  constantly 
subjected  to  the  vicissitudes  of  temperature,  the  nox 
ious  air  of  vessels,  and  the  stale,  salt  regimen  which 
is  used  at  sea. 

May  it  not,  then,  be  fairly  inferred,  that  whatever 
causes  impair  the  forces  of  the  organism,  serve  also 
to  render  it  less  able  to  resist  the  deleterious  influ 
ence  of  the  syphilitic  poison  ? 

In  regard  to  the  doctrine  of  Hahnemann  respect 
ing  the  identity  of  syphilis  and  sycosis,  we  agree  with 
Hartmann,  that  the  mass  of  evidence  upon  the  sub 
ject  renders  it  almost  conclusive  that  the  two  dis 
eases  are  distinct  in  their  nature.  The  origin 
of  each  is  in  a  specific  morbid  poison  capable  of 
impressing  the  organism  in  a  distinct  and  peculiar 
manner. 

Diagnosis. — There  are  unquestionably  a  great  va 
riety  of  ulcers  which  make  their  appearance  upon 


AND  GENITAL  ORGANS.  485 

the  genitals  after  impure  connections,  which  are  not 
syphilitic,  and  which  will  heal  over  without  causing 
constitutional  symptoms,  simply  by  the  aid  of  mild 
dressings.  The  true  syphilitic  chancre  is  now  of  rare 
occurrence,  but  the  great  majority  of  those  intract 
able  ulcers  which  are  looked  upon  as  real  venereal 
chancres,  are  nothing  more,  primarily,  than  simple 
non-infectious  sores,  which  have  been  converted  into 
an  unhealthy  condition  by  the  use  of  mercury.  Who 
can  doubt  this  fact  when  he  contemplates  the  dread 
ful  effects  which  a  course  of  mercury  often  produces 
on  the  healthy  organism  ?  Who  could  be  tempted,  in 
health,  to  take  the  enormous  quantities  of  this  drug 
wrhich  are  deemed  necessary  for  the  cure  of  syphilis  ? 
Let  the  provings  of  it — let  the  horrible  consequences 
which  its  accidental  absorption  sometimes  occa 
sions  upon  the  surface, — in  the  mucous  membranes, 
— the  bones, — the  glands  and  the  nervous  system, 
answer.  For  our  part,  we  would  prefer  the  foul 
syphilitic  poison  itself,  rather  than  the  uncontrollable 
ravages  of  such  an  enemy  as  mercury,  in  allopathic 
administrations,  is  admitted  to  be  by  the  fair-minded 
of  those  even  who  most  earnestly  defend  its  use. 

In  order  to  be  fully  convinced  that  many  of  the  ef 
fects  of  mercury  are  improperly  attributed  to  the 
action  of  the  syphilitic  virus,  it  is  only  necessary  to 
regard  carefully  the  symptoms  which  are  constantly 
presented  to  our  observation  in  what  are  called  ve 
nereal  affections,  and  to  notice  the  opinions  of  many 
of  the  most  eminent  medical  observers. 

Thus,  Sir  Astley  Cooper,*  in  his  lectures,  used  to 
observe,  "do  not  think  that  it  is  a  rare  occurrence 
for  the  penis  to  be  destroyed  by  mercury ;  no,  a 
chancre  that  has  remained  weeks  in  a  healthy  state, 
shall  become  irritable,  and,  by  maltreatment,  by  the 
injudicious  and  improper  use  of  mercury,  shall 
slough,  and  end  in  the  destruction  of  the  penis ;  this 
is  not  a  rare  case,  and  is  attributed  to  the  venereal 
disease,  but  in  reality  is  an  effect  of  the  improper  use 
of  mercury"  The  great  Hahnemann,  in  his  remarks 
upon  syphilis  and  sycosis,  constantly  alludes  to  the 

*  Castle's  Manual  of  Surg.,  p.  280. 


* 

486  DISEASES  OF  THE  URINARY 

pernicious  results  of  the  abuse  of  this  drug  in  the  hands 
of  the  allopathist. 

There  can  be  no  question  that  those  dreadful  muti 
lations  of  the  penis,  of  the  nose,  the  palate,  the  eyes, 
of  the  surface  of  the  body,  and  the  nodes  and  caries 
of  the  bones,  which  we  occasionally  observe,  are  all 
effects  of  mercury  and  not  of  syphilis ;  and  it  is 
in  the  highest  degree  probable  that  the  immunity  en 
joyed  by  the  Portuguese,  the  Mexicans,  and  certain 
other  nations,  from  the  severe  forms  of  this  malady,  is 
attributable  solely  to  the  fact  that  they  use  no  mer 
cury  in  its  treatment. 

Chancre. — The  primary  chancre  usually  presents 
itself  on  some  part  of  the  genital  organs,  in  from 
three  to  seven  days  after  contamination,  in  the  form 
of  a  darkish  red  pimple,  attended  with  slight  itching, 
and  surrounded  with  an  erysipelatous  blush.  In  a 
short  time  matter  forms  in  the  centre  of  the  pimple, 
and  an  excavated  ulcer,  with  a  yellowish  surface, 
hard  and  ragged  edges,  and  an  indurated  base,  makes 
its  appearance,  marking  the  sore  as  a  true  chancre. 
The  most  common  seat  of  primary  chancre  is  on  the 
inside  of  the  foreskin  arid  the  corona  glandis,  but 
it  occasionally  occurs  on  the  glands  and  the  exter 
nal  parts  of  the  genitals. 

Many  varieties  of  venereal  chancre  have  been  de 
scribed  by  authors,  as  the  simple,  the  indolent,  the  irri 
table,  the  sloughing,  the  indurated,  the  phagedenic  of 
Carmichael,  the  superficial  of  Mr.  Evans,  the  Hun- 
terian,&LC.  ;  but  as  these  diversities  in  the  appearance 
of  the  chancre  are  not  owing  to  any  difference  in 
the  character  of  the  virus,  but  to  the  condition  of  the 
patient  as  regards  constitution,  temperament,  and 
mode  of  life,  at  the  period  of  contamination,  we  should 
abstain  from  making  those  minute  classifications 
which  some  writers  have  attempted. 

The  circumstances  which  may  operate  to  modify 
the  character  and  appearance  of  a  simple  chancre,  or 
which  may  conduce  to  develop  primarily  an  intractable 
and  destructive  one,  are  numerous. 

Individuals  whose  constitutions  have  been  im 
paired  by  abuse  of  stimulants,  undue  exposure, 
hardship  and  fatigue,  and  insufficient,  nourishment, 


AND  GENITAL  ORGANS.  487 

are  liable  to  be  attacked  from  the  first  with  that 
variety  which  is  denominated  the  indurated  slough 
ing  chancre. 

Those  whose  systems  have  been  loaded  with  mer 
cury,  and  enfeebled  by  previous  disease,  are  peculiarly 
subject  to  that  description  which  is  termed  irritable  and 
sloughing.  Persons  who  go  from  temperate  to  tropical 
climates,  are  especially  in  danger  of  the  phagedenic 
variety.  Scrofula  and  scurvy  also  predispose  the 
system  to  this  form  of  it. 

The  simple  chancre  is  by  far  the  most  common,  par 
ticularly  in  temperate  latitudes,  and  usually  occurs  to 
individuals  of  a  sound  constitution.  Some  have  sup 
posed  the  cause  of  this  variety  to  consist  in  "  go- 
norrhoaal  matter,  and  other  morbid  vaginal  secre 
tions,"  brought  in  contact  with  the  penis  during 
coition  ;  but  of  this  there  is  no  proof.  The  simple 
ulcer  very  often  becomes  converted  into  an  irritable, 
sloughing,  or  erysipelalous  one,  by  some  excess  or 
imprudence  which  impairs  the  vigour  of  the  body,  or 
by  the  abuse  of  mercury.  On  the  other  hand,  so  long 
as  the  constitution  remains  sound  and  unimpaired, 
resistance  is  offered  to  the  action  of  the  virus,  and  the 
secondary  impression  which  it  makes  will  be  very 
slight,  and  in  some  instances  imperceptible.  It  is  in 
cases  of  this  description  that  we  sometimes  witness 
spontaneous  cures  of  what  was  originally  true  syphi 
litic  contamination. 

The  most  certain  marks  of  a  true  syphilitic  chancre 
are,  the  excavated  surface,  the  hard,  ragged  edges,  and 
the  indurated  base.  These  appearances,  taken  in  con 
nection  with  the  previous  history  of  the  case,  will  ge 
nerally  enable  us  to  decide  with  sufficient  certainty 
respecting  the  character  of  the  sore  ;  but  where  any 
doubt  exists,  we  would  most  strongly  commend  the 
practice  discovered  and  successfully  adopted  by  Ricord 
of  Paris,  of  inoculating  a  sound  part  with  the  matter 
from  the  suspected  ulcer.  In  case  a  second  chancre 
is  produced  by  this  operation,  there  will  no  longer  re 
main  a  question  in  regard  to  the  true  nature  of  the 
malady. 

After  the  syphilitic  poison  has  passed  from  the 
chancre  through  the  absorbent  glands  of  the  groin, 


488  DISEASES    OF   THE    URINARY 

into  the  blood,  it  possesses  a  specific  affinity  for 
only  three  parts  of  the  body,  viz.,  "  the  mucous  mem 
brane  of  the  throat  and  nose  ;  the  skin,  or  surface  of 
the  body  ;  and  the  bones,  with  their  periosteal  cover 
ings."*  Thus,  it  will  be  remarked,  that  the  internal 
organs  are  never  impressed  by  this  virus  ;  and  this 
fact  should  induce  the  allopath  to  pause  before  he 
loads  the  system  with  a  poison  which  spares  scarcely 
a  single  structure  during  its  operation. 

The  secondary,  or  specific  effects  of  the  syphilitic  virus, 
after  its  entrance  into  the  blood,  are  : 

First.  Upon  the  mucous  membrane  of  the  mouth 
and  throat,  which  becomes  red  and  inflamed,  and 
covered  in  some  parts  with  pimples,  which  soon  de 
generate  into  ulcers,  resembling  in  many  respects  the 
primary  simple  chancre.  These  ulcerations  extend 
into  the  nostrils,  and  sometimes  even  into  the  larynx 
itself,  giving  rise  to  loss  of  voice,  severe  cough,  vio 
lent  constitutional  disturbance,  and  death.  In  cases 
which  have  been  improperly  treated,  the  bony  palate 
and  the  nasal  bones  become  affected,  and  exfoliate, 
and  thus  cause  those  disgusting  mutilations  of  the  nose 
and  face  which  so  often  stare  the  old  school  physician 
in  the  face. 

Second.  Another  part  of  the  body  acted  on  by  the 
absorbed  virus  is  the  skin.  Its  manifestations  in  this 
case  are,  slightly  elevated  copper-coloured  eruptions 
of  different  sizes,  attended  with  uneasy  or  itching 
sensations,  sometimes  covered  with  a  kind  of  scurf  or 
scale,  or,  in  other  instances,  with  incrustations  and 
ulcerations.  These  eruptions  make  their  appearance 
on  the  face,  head,  breast,  palms  of  the  hands,  and 
arms.  Eruptions  which  are  called  tubercular,  often 
appear  on  the  scalp,  the  eyebrows,  the  breast,  back, 
and  arms,  and  ultimately  form  very  troublesome 
ulcers*  In  healthy  subjects  these  secondary  eruptions 
are  not  very  troublesome,  being  simply  copper- 
coloured  blotches,  covered  with  a  thin  scurf;  but  in 
irritable  and  impaired  constitutions  they  often  assume 
the  character  of  foul  and  sloughing  ulcers.  The  par 
ticular  variety  of  these  secondary  eruptions  will  be 

*  Sir  A.  Cooper's  Lectures. 


AND  GENITAL  ORGANS.  489 

determined  by  the  peculiarities  of  constitution  in  each 
individual  case,  and  not  from  any  original  difference 
in  the  virus  itself. 

Third.  Another,  and  the  last  portion  of  the  organism 
capable  of  being  impressed  by  the  absorbed  venereal 
poison,  is  the  osseous  structure,  with  its  periosteal 
covering.  The  morbid  inflammation  in  the  first  in 
stance  seizes  upon  the  periosteum,  causing  severe 
nocturnal  pains,  and  some  tumefaction  in  the  affected 
region.  If  the  malady  continues  to  increase,  an 
osseous  deposit  will  be  formed  between  the  perios 
teum  and  the  bone,  constituting  what  is  termed  the 
venereal  node.  This  node,  in  its  early  stages,  does  not 
usually  give  rise  to  much  inflammation  of  the  sur 
rounding  skin,  nor  is  it  attended  with  a  great  amount 
of  pain,  but  after  it  has  existed  for  a  considerable  time, 
and  particularly  if  the  patient  has  been  drugged  with 
mercurial  preparations,  it  becomes  quite  painful,  es 
pecially  during  the  night.  The  ordinary  location  of 
venereal  nodes  is  on  the  anterior  portion  of  the  tibia, 
or  on  the  surface  of  the  cranial  bones. 

We  believe  that  the  above-enumerated  symptoms 
constitute  all  of  the  legitimate  effects  resulting  from 
the  action  of  the  absorbed  syphilitic  virus.  The  great 
variety  of  eruptions  and  ulcerations  described  by 
Hartmann  and  others,  are  attributable  to  other  causes, 
operating  either  by  themselves,  or  in  conjunction  with 
the  venereal  poison.  It  is  of  vast  importance  in  af 
fections  of  this  description,  to  distinguish  with  all 
possible  accuracy  between  the  syphilitic  action  and 
that  of  mercury,  scrofula,  and  other  causes.  Far 
ther  on  we  shall  endeavour  to  make  this  distinction  as 
clear  as  possible. 

Bubo. — Another  primary  manifestation  of  syphilis 
consists  in  an  enlargement  of  one  or  more  of  the  ab 
sorbent  glands  of  the  groin,  termed  bubo.  This  en 
largement  usually  succeeds  the  chancre,  and  is  caused 
by  the  absorption  of  the  virus  of  the  latter.  It  is  rare 
in  real  syphilis  that  more  than  one  gland  in  each 
groin  becomes  affected  with  the  virus,  although  some 
of  the  other  glands  now  and  then  become  slightly 
swollen  from  sympathy.  The  swelling  ordinarily 
partakes  of  an  inflammatory  character,  and  if  not  op-. 


490  DISEASES    OF    THE    URINARY 

posed  by  appropriate  remedies,  runs  on  to  suppura 
tion,  and  sometimes  to  sloughing. 

The  disease  has  been  supposed  to  be  purely  local, 
until  after  the  swelling  in  the  groin  has  proceeded  to 
the  suppurative  stage  ;  but  this  is  evidently  erroneous, 
from  the  fact  that  secondary  symptoms  not  unfre- 
quently  occur,  without  there  having  been  any  previ 
ous  enlargement  of  the  gland  in  the  groin. 

Bubo  sometimes  makes  its  appearance  without  the 
previous  existence  of  a  chancre,  but  such  instances 
are  by  no  means  common.  Swellings  of  a  non- 
venereal  character  may  likewise  occur  in  the  groin 
from  a  strain,  or  from  too  great  violence  during  the 
indulgence  of  sexual  passion.  But  as  chancre  for 
the  most  part  precedes  the  bubo,  there  will  rarely  oc 
cur  any  difficulty  in  our  diagnosis. 

Therapeutics. — Hahnemann,  Gross.  Hartmann,  Hun 
ter,  Abernethy,  and  many  other  distinguished  members 
of  the  profession,  entertained  the  opinion  that  the  con 
stitutional  symptoms  of  syphilis  are  always  progress 
ive,  and  never  disappear,  unless  opposed  by  medicine  ; 
but  the  fact  is  now  completely  established,  not  only 
that  mercury  is  not  necessary  for  the  cure  of  either  the 
primary  or  secondary  symptoms,  but  that  they  often 
terminate  in  a  spontaneous  cure  without  any  medicine. 
We  are  assured  by  Dr.  Fergusson  and  other  surgeons 
who  have  observed  the  disease  in  Portugal,  that  the 
natives  cure  themselves  permanently  of  the  primary 
symptoms  by  simple  topical  applications  ;  and  of  the 
secondary  effects,  by  decoctions  of  sarsaparilla  and 
sudorifics.  They  remark,  that  "  the  virulence  of  the 
disease  has  there  been  so  much  mitigated,  that,  after 
running  a  certain  course  (commonly  a  mild  one) 
through  the  respective  order  of  parts,  according  to  the 
known  laws  of  its  progress,  it  exhausts  itself,  and 
ceases  spontaneously.'11 — (Med.  and  Chir.  Trans.,  vol.  iv. 
pp.  2-5).  This  is  still  further  corroborated  by  the 
numerous  cures  of  the  primary  and  constitutional 
symptoms  recorded  by  Messrs.  Rose,  Dease,  Hennen, 
Guthrie,  Good,  and  Whympor,  without  mercury,  or 
any  other  means  than  simple  dressings.  In  the  cases 
which  they  describe,  no  caries  of  the  bones  occurred,  as 
is  so  commonly  observed  when  mercury  is  used,  "  and 


AND  GENITAL  ORGANF.  491 

in  no  instance  was  there  that  uniform  progress,  with 
unrelenting  fury,  from  one  order  of  symptoms,  and 
parts  affected,  to  another,  which  is  considered  as  an 
essential  characteristic  of  true  syphilis." — (Med.  and 
Chir.  Trans.,  vol.  viii.,  p.  422). 

Hahnemann,  and  most  of  his  disciples,  as  well  as 
Hunter  and  other  eminent  allopathists,  entertained  an 
opinion  that  the  chancre  is  simply  the  vicarious  symp 
tom  of  the  internal  disease,  and  that  by  removing  this 
ulcer  by  external  applications,  "  the  disease  is  forced  to 
embody  itself  externally,  in  the  more  troublesome  and 
speedily  suppurating  bubo.  And  after  this,  too,  has 
been  removed,  as  is  foolishly  done,  by  external  treat 
ment,  the  disease  is  forced  to  manifest  itself  through 
out  the  organism  with  all  the  secondary  symptoms  of 
a  fully  developed  syphilis.  This  unavoidable  develop 
ment  of  the  internal  syphilitic  disease  generally  takes 
place  after  the  lapse  of  two  or  three  months." — (Hah 
nemann  s  Chronic  Diseases,  p*  116). 

We  speak  advisedly  when  we  pronounce  this  last  as 
sumption  altogether  erroneous ;  for  we  have  repeatedly 
seen  true  venereal  chancres  cured  by  topical  treatment 
alone,  while  the  patients  have  remained  entirely  free 
from  any  secondary  manifestations  for  years  after 
wards.  When  a  student  of  medicine,  the  author 
passed  some  time  at  the  United  States  Marine  Hos 
pital,  Chelsea,  then  under  the  superintendence  of  the 
able  and  accomplished  Dr.  Stedman.  In  this  in 
stitution,  the  internal  use  of  mercury  had  been  dis 
pensed  with  in  the  cure  of  syphilis,  for  several  years 
previous  to  my  entrance ;  and  I  ascertained  that  it  was 
a  very  rare  occurrence  to  observe  secondary  symptoms 
in  those  who  had  been  cured  at  this  hospital,  although 
patients  were  constantly  returning  with  other  com 
plaints,  who  had  been  cured  of  chancre  years  pre 
vious.  The  treatment  chiefly  relied  on  consisted  of 
topical  applications  of  a  mild  and  simple  character,  the 
internal  use  of  decoctions  of  sarsaparilla,  and  a  rigid 
regimen.  The  ordinary  period  for  the  cure  of  primary 
chancre,  was  from  three  to  four  weeks  ;  and  for  bubo, 
from  six  to  eight  weeks. 

So  long  as  a  chancre  exists,  the  matter  generated 
in  the  contaminated  part  continues  to  be  re-absorbed. 


492  DISEASES    OF   THE    URINARY 

and  thus  to  supply  new  fuel  to  the  mass  of  the  blood  ; 
it  is  therefore  important  to  change  the  morbid  action 
of  the  ulcer,  and  heal  it  up  as  soon  as  possible.  The 
matter  formed  in  ulcers  of  the  mucous  membrane  of 
the  throat,  which  have  arisen  from  the  constitutional 
effects  of  syphilis,  is  also  capable  of  propagating  the 
disease  by  contact  with  abraded  surfaces,  or  by  being 
directly  re-absorbed  into  the  blood.  There  is  reason 
to  believe,  therefore,  if  all  these  ulcers  be  speedily 
healed  by  topical  treatment,  so  that  the  blood  shall 
only  contain  a  given  quantity  of  the  virus,  this  limited 
amount  will  gradually  become  diluted,  by  the  constant 
addition  of  new  and  healthy  blood,  and  by  its  frequent 
circulation  through  the  lungs,  so  that  its  power  to  im 
press  the  structures  is  finally  lost,  and  the  parts  which 
have  already  been  affected,  gradually  recover  their 
health  and  tone. 

In  advocating  the  practice  of  topical  applications, 
however,  we  by  no  means  wish  to  be  understood  as 
placing  entire  reliance  upon  them,  to  the  exclusion  of 
internal  remedies.  We  only  assert  that  local  applica 
tions  are  capable  of  effecting  speedy  cures  of  chancres, 
thus  of  destroying  these  sources  of  contamination,  and 
placing  the  blood  in  the  most  favourable  condition  to 
be  purified  by  the  inspired  oxygen,  by  the  newly  formed 
blood,  and  by  remedial  agents.  A  morbid  action  is 
set  up  in  the  chancre,  which  causes  it  to  generate 
matter  of  a  virulent  quality.  This  is  evident  from  the 
fact  that  the  matter  of  buboes  and  other  venereal 
abscesses,  as  well  as  the  blood  of  syphilitic  persons, 
is  incapable  of  causing  contamination  in  the  healthy. 
We  repeat,  then,  heal  the  chancres  as  soon  as  possible, 
by  destroying  their  morbid  action,  with  some  local  ap 
plication  which  shall  induce  a  healthy  medicinal  action., 
and  we  have  already  done  much  towards  abridging 
the  power  of  the  disease.  Our  admirable  specifics 
will,  then,  readily  accomplish  what  remains  to  be 
done  in  perfecting  a  cure. 

The  remedial  agents  which  we  have  found  most 
useful  in  the  management  of  syphilis  are,  (topical,) 
nit.  argenti^  acid  nit.,  zinc  chlorid.,  liydrg.,  prcecip  , 
rub.  creosote,  and  (internal,)  the  preparations  of  mercury, 


AND  GENITAL  ORGANS.  403 

aurum  mur.,  thuya,  acid  nit.,  sulphur,  hepar  sulph..  sar- 
saparilla,  silicea,  mezereum,  hyd.  potasses. 

In  the  treatment  of  chancre,  our  attention  should  be 
directed  in  the  first  instance  to  the  cauterization  of  the 
sore,  in  order  to  change  as  speedily  as  possible  the 
morbid  action.  For  this  purpose,  either  of  the  first 
named  medicines  may  be  employed,  although  in  most 
cases  we  prefer  the  nitrate  of  silver  in  substance. 
After  a  healthy  action  has  been  excited  in  the  ulcer, 
by  these  applications,  lotions  of  simple  water  may  be 
employed  until  the  cure  is  established.  It  will  be  well 
to  keep  a  dossil  of  lint  moistened  with  water  constant 
ly  upon  the  ulcer.  This  course,  in  conjunction  with 
the  remedies  advised  below,  will  generally  effect 
speedy  and  permanent  restoration. 

Of  the  internal  remedies,  mercury  is  the  most  im 
portant.  By  comparing  the  pure  effects  of  the  differ 
ent  preparations  of  this  drug  upon  the  healthy  human 
organization,  with  the  constitutional  effects  of  the 
syphilitic  virus,  it  will  be  observed  that  the  former 
are  capable  of  causing  all  the  symptoms  of  the  latter, 
as  well  as  many  others  which  are  peculiar  to  the  drug:. 
According  to  Pereira,  the  following  are  the  effects  of 
mercury  in  large  doses : 

First.  On  the  mucous  membrane  of  the  nose  and 
throat:  ulcer  ations  of  the  mouth,  gums,  throat,  tonsils4, 
and  nose,  which  are  often  followed  by  extensive 
sloughing  of  the  parts. 

Second.  On  the  skin  or  surface  of  the  body  :  eczema 
mercuriale,  erythema  mercuriale,  lepra  mercurialis,  ery 
sipelas  mercuriale,  spilosis  mercurialis,  miliaria  mercuri 
alis,  and  other  cutaneous  eruptions  which  bear  a  close 
resemblance  to  herpes,  impetigo,  psydrasia,  and  the 
copper-coloured  eruptions  of  syphilis. 

Third.  On  the  bones  and  their  periosteal  coverings  : 
"  inflammation  of  the  bones  or  periosteum,  and  the 
consequent  production  of  nodes  (symphoresis  periostei 
mercurialis") 

By  the  above  it  will  be  seen  that  all  of  those  parts 
capable  of  being  impressed  by  the  venereal  virus,  are 
also  acted  on  by  mercury.  That  the  operation  of  the 
latter  is  often  more  violent  and  destructive  than  the 
former,  will  not  at  this  day  be  questioned. 


494  DISEASES    OF    THE    URINARY 

But  in  addition  to  the  symptoms  just  enumerated, 
mercury,  in  large  doses,  causes  almost  innumerable 
other  symptoms,  which  have  no  bearing  upon  the  sub 
ject  of  this  chapter,  except  as  indicating  its  danger  in 
the  hands  of  allopathists. 

We  have  quoted  above  from  an  eminent  allopathic 
writer,  in  order  that  every  reader  may  be  convinced 
of  the  analogy  between  the  effects  of  the  venereal 
poison  and  of  mercury,  upon  the  human  constitution, 
and  to  show  the  difficulty  of  distinguishing  between 
syphilitic  and  mercurial  symptoms,  in  the  old  school 
mode  of  practice. 

For  an  accurate  and  complete  description  of  the 
pure  effects  of  mercury  upon  the  healthy  organism, 
we  refer  to  the  provings  of  Hahnemann  and  other 
homoBopathists. 

Hahnemann  preferred  the  fluid  quicksilver,  carried 
up  to  the  decilionth  degree,  over  all  other  preparations, 
in  the  treatment  of  both  primary  and  secondary 
syphilis. 

For  the  cure  of  primary  chancre,  Hartmann  recom 
mends  the  first  or  third  trituration  of  mercurius  sol.,  in 
doses  of  one  grain,  night  and  morning.  If  no  improve 
ment  occurs  within  the  first  eight  days,  he  gives  a 
lower  trituration,  or,  if  necessary,  a  low  trituration  of 
mere,  prcecip.  rub.,  in  doses  of  one-sixth  of  a  grain,  two 
or  three  times  a  day.  In  the  Hunterian,  phagedenic, 
and  the  elevated  indurated  chancres,  Hartmann  em 
ploys  the  red  precipitate,  in  its  lower  attenuations,  from 
the  first. 

Dr.  C.  Miiller,  of  Leipsic,  is  also  most  decidedly  in 
favour  of  the  red  precipitate  or  the  hydr.  sulph.  rub.,  in 
the  treatment  of  syphilitic  chancres  and  buboes,  in 
whatever  state  they  may  present  themselves.  He 
advises  a  grain  of  the  first  trituration,  to  be  given 
twice  a  day  until  the  ulcers  have  nearly  healed.  For 
painful  nodes  and  other  syphilitic  affections  of  the 
bones,  hydriodate  of  potash  is  advised. 

I  have  also  made  use  of  the  precipitate  at  the  third 
attenuation,  with  marked  advantage,  in  uncomplica 
ted  syphilis.  I  have  known  the  best  results,  also,  from 
the  hydr.  murtcor.,  in  both  the  primary  and  secondary 
forms  of  the  malady.  For  the  cure  of  troublesome 


AND  GENITAL  ORGANS.  495 

secondary  symptoms,  in  the  forms  of  cutaneous  erup 
tions,  glandular  enlargements,  and  nodes,  theprotiodide 
of  mercury  has  extraordinary  power.  Speedy  cures 
have  been  effected  by  it  after  the  other  mercurial  pre 
parations  had  failed.  It  may  be  used  at  the  third 
attenuation,  in  doses  of  a  grain,  twice  a  day,  until  the 
eruptions  disappear* 

When  syphilis  is  complicated  by  psora,  scrofula,  or 
any  other  chronic  disease,  suitable  remedies  should  be 
alternated  \vith  the  mercurials. 

Muriate  of  gold  ranks  next  in  importance  to  mercury, 
as  a  remedy  in  secondary  syphilis.  The  late  Dr.  Taft, 
of  New  Orleans,  employed  it  in  secondary  ulcers  and 
eruptions  which  would  not  yield  to  mercury,  with  the 
most  gratifying  results.  In  syphilitic  eruptions  of  long 
standing,  we  have  often  administered  it  with  entire 
success.  The  second  or  third  trituration  may  be  em 
ployed,  in  half  grain  doses,  night  and  morning,  as  long 
as  necessary. 

Nitric  acid  will  be  serviceable  in  many  cases  of 
ill  conditioned  chancres,  which  seem  to  withstand  the 
curative  force  of  mercury.  It  is  also  of  great  value  in 
protracted  secondary  cases,  accompanied  with  emaci 
ation,  debility,  caries  of  the  bones,  unhealthy  ulcers 
upon  the  surface,  and  great  derangement  of  the  ner 
vous  system.  If  these  symptoms  have  been  aggrava 
ted  by  abuse  of  mercurials,  the  indication  is  still 
stronger  for  the  acid.  The  first,  second  and  third  di 
lutions  are  to  be  preferred  in  these  cases,  a  dose  to  be 
given  twice  daily  until  the  disease  yields. 

Sulphur,  hepar  sulph.,  and  hydr.  sulph.  rub.,  are  the 
proper  specifics  when  the  chancre  occurs  in  psoric 
constitutions.  As  a  general  rule,  the  two  first  should 
be  alternated  with  some  mercurial  preparation. 

Hyd.  potassce  is  eminently  worthy  of  consideration 
in  the  indolent  glandular  swellings  which  sometimes 
originate  from  a  combination  of  syphilis  and  scrofula. 
It  is  also  an  efficient  medicine  in  the  treatment  of 
venereal  nodes. 

Silicea,  mezereum  and  sarsaparilla  are  often  valuable 
auxiliaries  in  syphilis  complicated  with  scrofula. 
These  medicines  should  also  be  given  in  alternation 
with  some  other  suitable  specific. 


496  DISEASES    OF    THE    URINARY 

In  conclusion,  we  call  attention  to  the  following  re 
liable  mark  of  cure,  alluded  to  by  Hahnemann  in  his 
Chronic  Diseases :  "  So  long  as  the  original  spot  upon 
which  the  chancre  had  been  developed,  exhibits  a  red 
dish  morbid-looking,  red,  or  bluish  scar,  we  may  be 
sure  that  the  internal  disease  is  not  completely  cured  ; 
whereas,  if  the  chancre  has  been  removed  by  the  in 
ternal  remedy,  the  original  spot  of  the  chancre  can  no 
longer  be  traced,  on  account  of  that  spot  being  covered 
by  as  healthy-coloured  a  skin  as  the  rest  of  the  body." 

SECTION   X. 

LEUCORRHCEA FLUOR  ALDUS. WHITES. 

Diagnosis. — This  disease  is  characterized  by  a  dis 
charge,  from  the  utero-vaginal  structure,  of  a  mucous 
or  purulent  character,  of  a  white,  yellow,  or  greenish 
colour,  either  thin  and  watery,  or  of  the  consistence  of 
starch  or  gelatine.  This  discharge,  in  contradistinc 
tion  to  that  of  gonorrhoea,  arises  from  a  benignant  mor 
bid  action,  and  is  non-contagious.  The  assertion  of 
Hartmann,  respecting  the  identity  of  gonorrhoeal  and 
leucorrhoEal  inflammations — the  difference,  in  his  view, 
consisting  only  in  the  location  of  the  disease — is  evi 
dently  erroneous.  This  author  defines  gonorrhoea  to 
consist  of  an  inflammation  of  the  female  urethra,  and 
leucorrhoea  of  a  similar  inflammation  of  the  mucous 
membrane  of  the  vagina  or  uterus.  The  opinion  falls 
to  the  ground  when  we  reflect  that  the  latter  disease 
not  unfrequently  extends  to  the  urethral  mucous  mem 
brane,  giving  rise  to  ardor  urinae,  burning  pain  on  pass 
ing  water,  heat,  fulness,  and  swelling  of  the  part,  and 
a  purulent  discharge,  which  is  non-contagious.  Leu- 
corrhoeal  inflammation  always  originates  from  causes 
which  have  impaired  the  healthy  tone  of  the  mucous 
membrane  ;  gonorrhoeal  inflammation,  on  the  other 
hand,  may  arise  from  the  simple  contact  of  a  drop  of 
gonorrhoeal  matter  with  the  most  sound  and  healthy 
membrane.  The  former  is  the  result  of  an  ordinary 
inflammation,  which  is  analogous  in  its  character  to 
that  of  catarrh  and  chronic  bronchitis  :  the  latter  pro 
ceeds  only  from  the  application  of  a  specific  infectious 
matter,  which  developes  a  particular  morbid  inflam 
mation,  and  a  contagious  purulent  secretion. 


AND    GENITAL    ORGANS.  497 

The  character  of  the  discharge  and  of  the  symptoms, 
will  depend  upon  the  location  of  the  disease,  its  causes, 
and  the  amount  of  inflammation  present.  Inflamma 
tion  of  the  cervix  uteri,  for  example,  causes  a  discharge 
of  "  white  mucus,  and  when  the  inflammation  is  in 
tense,  tinged  with  blood." — (Hall)  Acute  vaginal  or 
urethral  inflammation  gives  rise  to  a  purulent  dis 
charge  of  a  yellow  or  greenish  colour,  sometimes  tinged 
with  blood.  A  more  chronic  affection  of  the  same 
parts  induces  a  thinner,  more  glairy,  and  muco-purulent 
secretion.  Scirrhus  uteri  causes  an  ichorous,  bloody 
and  foetid  discharge.  In  chlorotics,  with  deranged 
menstruation,  the  secretion  is  thin,  serous,  acrid,  and 
of  a  lightish  or  straw  colour.  The  discharge  which 
often  accompanies  pregnancy,  is  thick,  glairy,  and 
white  or  yellowish  ;  but  in  some  instances  after  ac 
couchement,  more  particularly  in  scrofulous  and  ca 
chectic  subjects,  the  matter  is  ichorous  and  highly  ir 
ritating  to  the  parts  with  which  it  comes  in  contact. 
In  polypi  of  the  uterus  or  vagina,  the  discharge  is  at 
first  mucous,  but  when  the  tumours  have  attained  some 
size,  it  becomes  tinged  with  blood,  and  in  some  cases 
of  this  kind  profuse  haemorrhages  occur.  The  signs 
which  denote  the  existence  of  these  tumours,  are,  sense 
of  weight  and  fulness  in  the  uterus,  dragging  pains  in 
the  small  of  the  back,  bearing  down  pains,  and  turns 
of  profuse  haemorrhage. 

In  light  cases  of  leucorrhoea,  the  discharge  is  usually 
thin,  glairy,  transparent,  and  starchy ;  but  when  the 
disease  is  thoroughly  seated,  and  the  patient  is  of  a 
delicate  or  cachectic  habit,  the  fluid  may  be  muco- 
purulent,  serous,  sanious,  and  of  a  white,  yellow,  or 
greenish  colour. 

As  a  general  rule,  the  discharge  is  worse  about  the 
period  of  the  monthly  sickness,  owing  probably  to  the 
increased  determination  of  blood  to  the  parts  during 
this  natural  phenomenon. 

The  diseases  which  are  ordinarily  accompanied  by 
leucorrhosa  are,  amenorrhoea,  chlorosis,  polypus  and 
scirrhus  uteri,  dysmenorrhoea,  menorrhagia,  prolapsus 
uteri,  and  chronic  inflammations  of  the  uterus,  vagina 
or  urethra. 

When  the  affection  is  inveterate,' and  attended  with 


DISEASES    OF    THE    URINARY 

an  abundant  discharge,  the  whole  system  becomes 
injuriously  affected  :  the  face  assumes  a  pale  or  sal 
low  colour  ;  the  eyes  are  surrounded  with  dark  or 
leaden-coloured  circles  ;  the  functions  of  the  stomach 
and  bowels  are  impaired ;  the  patient  experiences  a 
weary  and  dragging  sensation  in  the  left  side  ;  there 
are  also  dull  pains  in  the  back,  loins,  and  abdomen  ; 
cold  extremities  ;  nausea  ;  palpitation  and  dyspnoea 
after  exercising  ;  lassitude  ;  debility  ;  feeble  pulse  ; 
loss  of  physical  and  mental  energy  ;  partial  or  total 
suppression  of  the  menses  ;  increase  or  diminution  of 
the  sexual  propensity. 

These  are  the  symptoms  to  which  protracted  and 
severe  attacks  of  leucorrhoea  give  rise  ;  but  the  mala 
dy  may  exist  for  years,  in  a  mild  form,  without  the 
development  of  any  of  these  consequences. 

This  disease  is  far  more  common  in  cities  amongst 
the  rich,  indolent,  luxurious,  and  dissipated,  than  in 
the  country.  Indeed,  the  small  number  of  births,  and 
the  frequent  miscarriages  occurring  in  large  towns, 
are  attributable  in  a  great  measure  to  the  very  com 
mon  prevalence  of  this  weakness. 

LeucorrhoBa  has  been  considered  as  one  of  the  symp 
toms  of  prolapsus  uteri  ;  but  we  are  of  opinion  that  in 
very  many  instances,  the  latter  is  a  consequence,  rather 
than  a  cause  of  the  former.  This  opinion  derives  sup 
port  from  the  fact  that  fluor  albus  often  exists  for  years 
before  the  signs  of  prolapsus  manifest  themselves : 
and  it  is  probably  from  this  circumstance  that  the 
tone  of  the  uterus  becomes  impaired,  and  the  muscles 
and  ligaments  gradually  lose  their  strength  and  con 
tractility. 

Leucorrhoea  occurs  at  all  periods  of  life,  but  is  most 
common  after  puberty,  and  previous  to  the  "  change 
of  life,"  when  so  many  causes  are  constantly  conspiring 
to  induce  free  determinations  of  blood  to  the  utero- 
genital  organs. 

Causes. — The  conditions  which  predispose  to  attacks 
of  leucorrhosa,  may  be  enumerated  as  follows  :  a  lym 
phatic  temperament  ;  a  scrofulous  dyscrasia  ;  general 
debility  and  relaxation  of  the  muscular  and  membra 
nous  structures,  whether  from  natural  organization,  or 
previous  disease. 


AND  GENITAL  ORGANS.  499 

Amongst  the  more  immediate  causes  may  be  men 
tioned,  an  inactive  and  luxurious  mode  of  life  ;  im 
moderate  sexual  indulgence  ;  abortions ;  congestions 
and  inflammations  of  the  uterus  and  vagina  ;  men 
strual  derangements ;  want  of  cleanliness  ;  a  humid 
atmosphere  ;  scirrhus  uteri  ;  polypi  and  other  abnor 
mal  growths  in  the  uterus  ;  metastases  of  rheumatism  ; 
herpes  ;  hcemorrhoidal,  catarrhal,  and  bronchial  in 
flammations  ;  the  uterine  debility  and  relaxation  con 
sequent  on  parturition,  and  too  early  exercise  after 
confinement ;  neglect  of  mothers  to  exercise  the  of 
fice  of  nursing  ;  and  finally,  according  to  Marshall 
Hall,  undue  lactation. 

All  of  these  causes  doubtless  exercise  an  influence  in 
the  production  of  fluor  albus,  but  in  the  vast  majority 
of  cases  the  disease  may  be  justly  attributed  to  the 
combined  operation  of  several  of  these  influences, 
rather  than  to  any  single  one.  We  may  almost  pre 
dict  beforehand,  that  the  child,  born  of  parents  who 
have  always  lived  in  compactly  populous  cities,  and 
have  indulged  in  their  artificial  habits,  will  sooner  or 
later  be  afflicted  with  leucorrhcea.  This  is  but  one 
of  the  signs  which  indicate  the  gradual  but  sure  pro 
gress  of  degeneration  to  which  the  luxurious  and  dis 
solute  habits  of  large  towns  inevitably  lead.  In  the 
first  instance,  indolence,  stimulating  drinks,  over 
heated  apartments,  exciting  theatrical  exhibitions, 
romances,  pictures,  statuary,  etc.,  all  tend  to  divert 
the  mind  towards  sensual  enjoyments.  Deprived  in  a 
great  measure  of  those  pure  and  sublime  pictures 
which  nature  has  so  lavishly  scattered  throughout  the 
country,  to  please  the  sight,  to  elevate  the  mind,  and 
to  ennoble  and  purify  the  whole  being ;  and  of  the 
thousand  sources  of  happiness  which  pertain  to  coun 
try  life  ;  they  turn  to  artificial  pleasures,  and  reap  the 
fruits  which  are  ever  entailed  by  a  violation  of  natural 
laws. 

Is  it  strange  then  that  fluor  albus  is  so  common  in 
cities  ?  that  the  degenerate  offspring  of  these  artificial 
human  beings  should  grow  up  so  puny,  so  weak,  men 
tally  and  physically;  so  prone  to  disease,  and  soinca- 
pable  of  performing  properly  those  functions  for  which 
nature  has  designed  them  ?  If  any  one  doubts  the  in- 


500  DISEASES    OF    THE   URINARY 

ferences  which  these  remarks  suggest,  let  him  but  ob 
serve  the  families  of  the  wealthy  and  luxurious,  who 
have  inhabited  large  cities  for  two  or  three  genera 
tions,  and  he  will  doubt  no  longer. 

Prognosis. — Leucorrhcea  often  leads  to  prolapsus 
uteri,  amenorrhoea,  menorrhagia,  abortion,  anasarca, 
hysteria,  and  general  debility,  but  it  very  rarely  ter 
minates  fatally.  By  impairing  in  a  gradual  manner 
the  energies  of  the  system,  it  predisposes  it  to  take  on 
serious  disordered  action  from  slight  causes,  and  thus 
becomes  indirectly  an  important  morbid  agent-  When 
the  complaint  is  recent,  and  occurs  in  females  of  a  ro 
bust  constitution,  from  some  temporary  congestion, 
difficult  parturition,  or  mechanical  injury,  we  may  ex 
pect  to  remove  it,  by  the  aid  of  suitable  remedies,  in  a 
short  period  ;  but  if  the  patient  be  of  a  lymphatic  tem 
perament,  of  a  delicate,  lax  and  scrofulous  constitution, 
and  subject  to  irregular  menstruation,  the  disease  will 
most  probably  baffle  our  best  curative  efforts,  and  per 
sist,  with  a  greater  or  less  degree  of  severity,  during 
life.  In  individuals  of  this  description,  the  most  insig 
nificant  causes  are  capable  of  inciting  and  perpetuat 
ing  the  weakening  discharge,  so  that,  in  many  cases, 
it  will  prove  a  hopeless  task  to  attempt  to  remove  all 
the  influences  which  exercise  an  injurious  bearing  up 
on  the  case.  Even  when  the  affection  exists  as  a 
mere  symptom  of  some  other  disease,  it  seldom  sub 
sides  \vith  the  other  symptoms,  but  is  quite  prone  to 
degenerate  into  a  chronic  fluor  albus. 

Therapeutics — There  are  several  conditions  which 
are  absolutely  essential  to  the  successful  treatment  of 
"  whites,"  the  most  important  of  which  are,  abundant 
active  exercise  in  the  open  air  ;  an  avoidance  of  all  ex 
cesses  in  venery,  and  in  the  pleasures  of  the  table ;  a 
withdrawal  of  the  thoughts  and  affections  from  exciting 
spectacles,  from  crowded  balls  and  parties,  from  las 
civious  imaginings,  from  romances,  and  intrigues  ;  and 
lastly,  frequent  daily  ablutions,  in  order  to  ensure  the 
most  perfect  cleanliness  of  the  utero-genital  organs. 

The  vast  importance  of  this  last  point  cannot  be  too 
strongly  insisted  upon,  for  without  a  rigid  attention  to 
cleanliness,  all  our  efforts  will  prove  futile.  The  mor 
bid  secretion  is  at  best  sufficiently  irritating,  but  when 


AND  GENITAL  ORGANS.  501 

it  is  permitted  to  accumulate  and  remain  for  a  long 
time  in  contact  with  the  mucous  membrane,  it  be 
comes  partially  decomposed,  fetid,  and  highly  perni 
cious  to  the  well-being  of  the  parts.  On  this  account, 
the  constant  and  thorough  use  of  local  applications  of 
tepid  or  cold  water,  as  circumstances  require,  should 
be  strictly  enjoined.  We  may  then  carry  out  our  re 
medial  measures  in  all  their  details,  with  a  reasona 
ble  prospect  of  success. 

We  call  attention  to  the  following  remedies  :  Cal- 
carea  carb.,  sulphur,  stannum,  sepia,  iodine,  pulsatilla, 
alumina,  lycopodium,  phosphorus,  cocculus,  sabince,  secale 
cor.,  china,  arnica,  bovista,  aconite,  mercurius,  nux 
vom.,  silicea,  psoricum,  copaibce,  mezereum,  and  manga- 
num. 

Calcarea  carb.  is  suitable  in  chronic  leucorrhoea, 
affecting  weak,  scrofulous  and  cachectic  females,  and 
particularly  indicated  when  the  menses  are  too  fre 
quent  and  too  profuse.  The  discharge  is  milky,  trans 
parent,  mucilaginous,  starchy,  unirritating,  and  ac 
companied  with  itching  of  the  parts,  especially  the 
pudendum  ;  also  lassitude  ;  depression  of  spirits  ;  pains 
in  the  chest  and  back ;  cough  ;  and  general  debility. 

When  the  complaint  arises  from  a  scrofulous,  or 
psoric  taint,  antipsorics,  like  sulphur,  stannum,  and  io 
dine,  will  be  required.  The  discharge  in  these  cases 
is  thin  or  yellowish,  and  highly  irritating  to  the  parts 
with  which  it  comes  in  contact.  The  strength  is  also 
much  impaired,  and  there  are  indications  of  pulmona 
ry  and  scrofulous  disorder,  such  as  hectic  fever  ;  ema 
ciation  ;  loss  of  appetite ;  wandering  pains  in  the 
chest ;  cough ;  profuse  mucous  or  purulent  expecto 
ration  ;  feeble  and  rapid  pulse  ;  night-sweats. 

Sepia  is  suitable  for  females  who  are  naturally  del 
icate  and  sensitive,  with  clear  and  transparent  com 
plexions.  The  discharge  is  mucous,  white,  yellowish, 
or  watery,  mild  or  acrid  in  its  nature,  most  abundant 
just  before  or  just  subsequent  to  the  menses,  and  at 
tended  with  itching  and  stitching  pains  in  the  genital 
organs. 

Pulsalilla  is  an  admirable  remedy  in  leucorrhoBa 
accompanying  pregnancy.  It  is  also  useful  when  the 
disease  occurs  about  the  period  of  the  monthly  courses. 


502  DISEASES    OF    THE    URINARY 

The  discharge  may  be  thin,  acrid,  and  burning,  or 
thick,  white,  and  tenacious,  like  the  white  of  eggs. 
Shifting  flatulent  pains  in  the  abdomen  still  farther 
point  to  pulsatilla. 

Alumina  has  proved  successful  in  several  varieties 
of  fluor  albus  ;  but  is  particularly  indicated  when  the 
discharge  is  very  profuse  and  acrid,  most  abundant 
during  the  day  when  walking,  and  previous  to  the 
menstrual  periods,  and  attended  with  a  burning  and 
itching  sensation  in  the  genital  organs  and  rectum. 

Fluor  albus  brought  on  by  masturbation,  and  occur 
ring  at  intervals,  with  a  milky,  serous,  ichorous,  or 
reddish  discharge,  will  be  best  covered  by  lycopodium, 
phosphorus,  or  cocculus.  These  remedies  are  suitable 
to  lymphatic  temperaments,  to  those  who  are  highly 
sensitive  to  cold,  and  subject  to  catarrhal  affections, 
and  whose  nervous  systems  have  been  morbidly  ex 
cited. 

Sabince  and  secale  cornutum  are  proper  in  fluor  al 
bus  depending  upon  weakness  of  the  utero-vaginal 
structure  ;  also  when  arising  from  suppression  of  the 
menses  ;  from  miscarriage  ;  from  severe  and  protract 
ed  labours  ;  polypi,  and  prolapsus  uteri.  The  discharge 
is  attended  with  itching  of  the  pudendum,  and  inordi 
nate  sexual  propensity. 

China  will  serve  our  purpose  when  the  complaint 
originates  from  excessive  loss  of  blood,  or  other  ani 
mal  fluids,  extreme  debility  from  fevers,  acute  inflam 
mations,  abuse  of  drugs,  insufficient  nutriment,  and 
respiration  of  foul  air. 

Bovista  is  applicable  in  fluor  albus  occurring  after 
the  catamenia,  with  discharge  of  a  thick,  glairy,  and 
tenacious  matter,  of  a  yellow  or  greenish  colour,  and 
highly  corrosive. 

Arnica  is  indispensable  in  leucorrhoea  originating 
from  mechanical  injuries  during  accouchement,  from 
polypi,  hydatids,  and  other  morbid  growths  in  the 
uterus  or  vagina,  prolapsus  uteri,  and  undue  mechan 
ical  pressure  from  without. 

Aconite  corresponds  to  plethoric  and  sanguine  con 
stitutions,  and  to  females  who  are  subject  to  conges 
tions  and  haemorrhages  from  different  organs.  The 
discharge  is  purulent,  yellow  or  greenish,  and  attended 


AND  GENITAL  ORGANS.  503 

with  ardor  urinae,  heat,  pain,  and  fulness  in  the  geni 
tal  organs,  quick  and  full  pulse,  hot  skin,  and  other 
febrile  symptoms. 

When  there  is  reason  to  suspect  that  the  discharge 
is  from  a  syphilitic  origin,  whether  it  be  mucous, 
watery,  or  purulent,  mild  or  corrosive,  mercurius  is 
our  best  remedy. 

Nux  vom.  is  recommended  when  the  disease  arises 
from  irregular  menstruation,  abuse  of  stimulants,  rich 
and  indigestible  food,  with  a  very  profuse  sanguineous 
or  yellowish  and  fetid  mucous  discharge,  and  attended 
with  cramplike  pains  in  the  abdomen,  constipation, 
sinking  at  the  stomach,  and  palpitation  of  the  heart. 

Cases  may  occur  which  will  require  the  use  of  sili- 
cea,psoricum,copaibce,  mezereum,  manganum,  nitric  acid, 
to  which  the  reader  is  'referred. 

Administration. — We  advise  the  employment  of  the 
first,  second,  and  third  attenuations,  the  dose  to  be 
repeated  once  in  twenty-four  hours  until  primary  or 
secondary  medicinal  symptoms  appear,  when  we  may 
await  the  result  for  some  days,  or  so  long  as  the 
amendment  continues.  When  the  symptoms  become 
stationary,  we  may  again  resort  to  the  remedy. 

SECTION  XI. 

AMENORRHGEA. 

General  description. — Many  of  the  symptoms  of 
this  complaint  bear  a  close  resemblance  to  those  of 
chlorosis,  and  it  is  on  this  account,  probably,  that 
some  authors  have  confounded  the  two  maladies.  As 
retention  or  suppression  of  the  menses  is  a  very  com 
mon  and  prominent  symptom  of  chlorosis,  it  is  not 
surprising  that  it  has  been  deemed  a  cause  of  chlorotic 
symptoms,  rather  than  as  a  mere  symptom.  But  the 
fallacy  of  this  doctrine  will  be  evident,  when  we  re 
flect  that  chlorosis  occurs  in  males,  in  young  children, 
and  in  females  whose  catamenial  functions  are  regu 
lar  through  the  whole  course  of  the  disease. 

Two  kinds  of  menstrual  irregularity  are  generally 
included  under  the  above  head  :  first,  retention  of  the 
catamenial  flux  beyond  the  natural  period,  from  con- 


504  DISEASES    OF    THE   URINARY 

stitutional  causes  or  mechanical  obstruction ;  and 
second,  partial  or  total  suppression  of  already  estab 
lished  courses,  from  phthisis,  chronic  hepatitis,  general 
debility,  chlorosis,  fevers,  and  exposure  to  cold  and 
dampness. 

It  is  not  improbable  that  the  same  causes  which 
contribute  to  the  development  of  chlorosis,  also  ope 
rate  to  prevent  the  usual  menstrual  flux  at  the  period 
of  puberty,  and  thus  to  establish  one  variety  of  ame- 
norrhcea.  Natural  delicacy  of  constitution,  a  highly 
impressible  nervous  system,  and  a  lymphatic  temper 
ament,  are  'general  conditions  which  precede  and  ac 
company  both  maladies,  although  amenorrhcea  some 
times  occurs  in  the  most  robust  females. 

The  revolution  which  nature  causes  in  the  female 
organism  at  the  period  of  puberty,  ought  always  to 
become  manifest  in  the  menstrual  flux ;  but  the  causes 
which  often  operate  to  retard  it,  and  thus  to  thwart 
the  kind  efforts  of  nature,  are  numerous  and  diversified. 

Singular  phenomena  are  sometimes  observed  at  the 
period  of  puberty  in  relation  to  this  periodical  evacu 
ation  ;  for,  in  the  place  of  the  usual  uterine  secretion, 
fluxes  now  and  then  take  place  from  the  top  of  the 
head,  the  ends  of  the  fingers,  the  soles  of  the  feet,  the 
stomach,  intestines,  nose,  and  other  parts  of  the  body, 
and  apparently  assuming  the  place  of  the  monthly 
periods.  Occasionally  the  supplementary  secretion 
occurs  in  the  form  of  ulcers,  enlargement  and  irrita 
tion  of  certain  veins,  and  eruptions. 

The  menstrual  discharge  varies  much  in  its  quan 
tity  and  character.  In  hot  climates,  puberty  arrives 
earlier,  and  the  discharge  is  more  abundant,  than  in 
temperate  latitudes* 

When  the  discharge  comes  on  at  the  proper  period, 
but  is  deficient  in  quantity,  or  is  composed  of  serum, 
mucus,  or  pus,  other  parts  of  the  economy  suffer,  as 
by  pains  in  the  back,  pelvis,  limbs,  and  head,  until 
the  period  has  passed,  after  which  the  sufferings  abate 
until  the  succeeding  epoch,  and  are  then  renewed. 
This  deficient  secretion  may  continue  for  months  and 
even  years,  without  giving  rise  to  any  structural  le 
sion,  or  any  other  symptoms  than  those  enumerated, 
when  some  new  circumstance,  like  marriage,  a  sea- 


AND  GENITAL  ORGANS.  505 

voyage,  or  change  of  climate,  may  restore  the  func 
tion  to  its  natural  condition. 

Puberty,  with  its  usual  accompaniment,  the  men 
strual  flux,  does  not  occur  in  cold  regions  until  the  age 
of  fifteen  or  sixteen  years,  while  in  tropical  countries, 
it  arrives  at  the  age  of  eight,  nine,  and  ten  years. 
Frank*  records  cases  where  the  courses  appeared  in 
children  of  one,  three,  and  four  years.  This  physician 
also  treated,  at  Pavia,  a  woman  who  had  given  birth 
to  three  children  without  ever  having  had  a  menstrual 
or  lochial  discharge.  Many  cases  of  this  kind  are 
mentioned  by  other  writers,  who  also  allude  to  the 
masculine  organization  and  characteristics  of  these 
women,  such  as  firmness  of  muscle,  harshness  of  voice, 
and  smallness  of  the  breasts. 

From  these  facts  we  infer  with  Frank  and  others, 
that  the  menstrual  function  is  not  absolutely  essential 
to  the  occurrence  of  conception,  and  that  a  woman 
may  go  through  her  whole  term  of  pregnancy,  and 
finally  give  birth  to  a  healthy  child,  without  any  de 
velopment  whatever  of  the  catamenial  function. 

Frank,  in  his  Practice  of  Medicine,  expresses  the 
same  opinion :  "  Nous  concluons  de  ces  observations 
que  I'apparition  des  menstnies  est,  a  la  verite,  un  des 
principaux  signes  qui  annoncent  le  de veloppment  de 
1'organe  uterin  et  1'abord  du  sang  dans  ses  vaisseaux, 
mais  que  la  conception  et  la  nutrition  du  foetus  pen- 
vent  egalement  s'operer,  quoique  cette  fonction  pe- 
riodique  ne  soit  pas  encore  etablie ;  que  la  fecondite 
depend  d'une  autre  cause,  d'un  principe  analogue  a 
celui  dont  elle  derive  chez  les  femelles  des  animaux  ; 
que  la  nature  a  soumis  en  general  toutes  les  femmes 
bien  organisees  au  tribut  menstruel,  mais  qu'elle  ne 
Texige  pas  toujours  avec  la  meme  rigueur  sous  peine 
de  sterilite." 

In  regard  to  the  natural  duration  of  the  catamenial 
discharge,  nothing  definite  can  be  advanced,  since  so 
much  depends  upon  the  constitution,  the  climate,  and 
the  habits  of  life  ;  but  the  average  duration  is  about 
three  or  four  days. 

Diagnosis. — As  the  period  approaches  when  the  girl 

*  Traite  de  Mcd.  Practique,  vol.  ii.,  p.  253. 
22 


506  DISEASES    OP    THE    URINARY 

is  to  become  a  woman,  new  ideas,  new  thoughts,  and 
new  desires  take  possession  of  her  mind.  Instead  of 
amusing  herself  with  her  doll,  she  prefers  to  enjoy, 
although  with  much  coyness  and  timidity,  the  society 
of  an  attractive  young  friend  of  the  other  sex ;  in 
stead  of  the  romping  freedom  of  the  child,  we  now 
observe  the  retiring  manners  and  the  burning  blushes 
of  the  maiden.  Her  physical  developments,  also, 
become  more  symmetrical,  perfect,  and  pleasing  to 
the  eye,  and  she  looks  forward  into  the  dim  vista  of 
life  with  deeper  interest,  higher  aspirations,  and  a 
more  proper  appreciation  of  the  responsible  duties 
she  may  be  called  upon  to  fulfil. 

If,  in  conjunction  with  these  physical  and  moral 
changes,  the  catamenial  discharge  makes  its  appear 
ance  naturally  and  regularly,  the  girl  retains  her 
health  and  vigour  ;  but  if  the  period  passes  by  with 
out  the  usual  development  of  the  monthly  tribute,  we 
are  presented  with  the  following  symptoms  of 

RETENTION    OP    THE    MENSES. 

Pale,  waxlike,  or  sullen  and  sickly  countenance; 
furred  tongue,  and  foul  breath  in  the  morning  ;  varia 
ble  and  sometimes  morbid  appetite ;  nausea,  general 
debility,  lassitude,  and  sense  of  fatigue  ;  pains  in  the 
small  of  the  back,  pelvis,  abdomen,  head,  side,  and 
limbs  ;  disinclination  to  mental  or  physical  exertion  ; 
coldness  of  the  feet ;  constipation ;  leucorrhoea ;  de 
pression  of  spirits  ;  sad  and  weeping  mood  ;  distress 
in  the  stomach  after  eating ;  distention  of  the  abdo 
men  ;  faiiitness  ;  palpitation  of  the  heart  after  exer 
cise  ;  rapid  pulse  ;  headache  ;  vertigo  ;  roaring  in  the 
ears  ;  nightly  wake  fulness  ;  hysteric  symptoms  ;  pee 
vishness  and  irritability  ;  haemorrhages  from  the  nose, 
stomach,  lungs,  and  rectum  ;  supplementary  dis 
charges  from  certain  parts  of  the  body. 

SUPPRESSION     OF    THE    MENSES, 

May  arise  from  a  natural  cause,  like  pregnancy,  or 
from  general  debility  resulting  from  excessive  loss  of 
blood,  chronic  and  acute  diseases,  inordinate  mucus, 
purulent  and  seminal  discharges,  polypi,  venereal  ex 
cesses,  constant  and  severe  muscular  exertion,  and 


AND  GENITAL  ORGANS.  507 

mechanical  obstructions  ;  or  it  may  occur  suddenly 
during  the  flux  from  violent  emotions  of  the  mind, 
exposure  to  cold  and  dampness,  cold  baths,  or  any 
other  cause  which  abruptly  shocks  the  system. 

The  symptoms  which  follow  suppression  are  usually 
more  acute  and  dangerous  than  those  of  retention  of 
the  courses.  It  is  not  uncommon  for  the  former  to 
induce  serious  haemorrhages  from  the  lungs  and  stom 
ach,  also  inflammations  and  congestions  of  the  brain, 
lungs,  uterus,  and  liver ;  while  in  the  latter,  the  symp 
toms  arise  so  gradually,  that  the  organism  in  some 
measure  adapts  itself  to  the  morbid  condition,  and 
thus  escapes  the  inflammatory  and  febrile  attacks 
which  are  so  common  in  suppression. 

Suppression  occurs  in  the  most  sound  and  robust 
constitutions,  as  well  as  in  those  that  are  weakly :  re 
tention  but  rarely  happens  in  healthy  and  vigorous 
subjects,  but  follows  usually  as  a  consequence  of  ori 
ginal  delicacy  of  constitution,  or  of  some  long  stand 
ing  chronic  affection.  The  symptoms  of  the  former 
are  more  violent  than  those  of  the  latter,  but  upon  the 
whole,  less  dangerous  to  life,  and  more  readily  con 
trolled  by  medicines. 

In  cases  where  the  monthly  secretion  takes  place, 
but  is  retained  in  the  uterus  from  some  mechanical 
obstruction,  the  blood  often  preserves  its  fluidity  and 
freshness  for  a  long  period.  This  is  owing  to  the  ex 
clusion  of  the  oxygen  of  the  air,  the  presence  of  which 
is  essential  to  the  process  of  decomposition. 

Causes. — Natural  or  acquired  delicacy  of  constitu 
tion,  combined  with  a  lymphatic  temperament,  and  a 
highly  sensitive  nervous  system,  is  by  far  the  most 
common  cause  of  retarded  menstruation.  A  certain 
amount  of  stamina,  of  physical  and  nervous  energy, 
is  essential  to  the  healthy  performance  of  the  func 
tions,  and  so  long  as  the  organism  is  without  the 
proper  supply  of  this  force,  all  of  the  functions  must 
be  imperfectly  executed. 

Structural  lesions  which  give  rise  to  profuse  puru 
lent,  mucous,  or  sanguineous  discharges,  operate  both 
as  causes  of  retention  and  suppression.  In  this  class 
may  be  included,  tuberculous  ulcerations  of  the  lungs, 


508  DISEASES    OF    THE    URINARY 

chronic  bronchitis,  abscesses  of  the  liver,  and  lumbar 
abscess. 

Other  causes  of  retention,  are,  malformations  of  the 
uterine  organs,  or  the  vagina,  like  imperforate  os 
tincae,  imperforate  hymen,  malorganization  of  the 
ovaries  or  fallopian  tubes,  unnatural  growths  in  the 
uterus  or  vagina  which  oppose  an  obstruction  to  the 
passage  of  the  menstrual  secretion. 

Dr.  Mclntosh  divides  the  mechanical  obstructions  to 
the  discharge  of  the  menstrual  fluid,  into  two  classes, 
viz. :  "  those  occasioned  by  cohesion  of  the  sides  of  the 
vagina  and  labia,  and  an  imperforate  hymen,  and  those 
caused  by  an  imperfect  or  imperforated  state  of  the  os 
uteri  itself.  All  these  cases  are  comparatively  rare, 
but  few  men  can  have  been  in  extensive  practice  for 
twenty  years,  without  meeting  with  several,  and  there 
fore  they  require  some  notice  in  this  place.  In  the 
first  set  of  cases,  in  addition  to  the  constitutional  symp 
toms  and  local  pain  already  mentioned,  there  is  great 
fulness,  distention,  and  a  sense  of  weight  in  the  pas 
sages,  accompanied  sometimes  with  severe  pain,  and 
a  feeling  of  bursting ;  straining  at  stool  and  micturi 
tion,  together  with  enlargement  of  the  abdomen,  which 
excites  suspicion  of  pregnancy.  The  nature  of  the 
case  can  only  be  determined  by  examination,  and  can 
be  relieved  only  by  the  knife. 

"  In  the  second  set  of  cases,  there  is  greater  difficulty 
in  detecting  the  state  of  parts,  from  the  natural  im 
pediment  to  an  examination  which  exists  at  the  orifice 
of  the  vagina  ;  but  I  may  mention,  at  least  as  a  curious 
coincidence,  that  in  the  only  two  cases  of  imperforated 
os  uteri  which  have  fallen  within  my  observation, 
there  was  no  hymen,  and  the  passages  easily  admitted 
the  introduction  of  two  fingers."  Dr.  M.  punctured 
the  os  uteri,  in  one  of  these  cases,  and  afterwards  di 
lated  the  passage  with  bougies,  until  the  discharge 
found  free  exit,  when  all  of  the  unpleasant  symptoms 
subsided,  and  the  patient  was  restored  to  perfect  regu 
larity  and  excellent  health.  The  other  patient,  whose 
delicacy  forbade  the  operation,  gradually  sank  under 
her  symptoms  and  died.  I  have  met  with  one  case  of 
retention,  from  adhesion  of  the  walls  of  the  vagina. 
The  patient  was  a  healthy  young  married  lady  whose 


AND  GENITAL  ORGANS.  509 

menstruations  had  been  regular  until  she  became  preg 
nant,  after  which  they  ceased,  and  she  advanced  as 
usual  until  the  fifth  month,  when  she  had  the  misfor 
tune  to  miscarry.  During  the  delivery  of  the  foetus, 
so  much  violence  occurred  to  the  parts,  that  inflamma 
tion  and  sloughing  of  the  vagina  followed,  adhesions 
took  place  between  the  vaginal  walls,  and  the  passage 
became  entirely  closed  to  the  escape  of  the  menstrual 
fluid.  The  patient  experienced  for  many  months  most 
severe  pains  in  the  pelvis,  abdomen,back,  and  especially 
at  the  monthly  periods ;  many  severe  constitutional 
symptoms  set  in,  and  she  became  reduced  to  a  very 
low  state  of  health.  A  free  incision  through  the  cica- 
trix,  gave  vent  to  a  large  quantity  of  fluid  blood,  ex 
hibiting  but  slight  signs  of  decomposition,  and  the  pa 
tient  speedily  regained  her  health. 

The  most  harmless  cause  of  suppression,  is  that 
which  arises  from  pregnancy.  But  although  this  is  a 
natural  cause,  its  constitutional  effects  are  manifested 
in  the  form  of  frequent  nausea,  morning  sickness, 
ptyalism,  &c.  These  symptoms,  although  quite  trouble 
some  and  annoying  to  the  patient,  serve  the  important 
purpose  of  guarding  the  brain,  lungs,  and  other  vital 
parts,  from  dangerous  inflammations  and  congestions. 

One  of  the  most  notable  causes  of  suppression  du 
ring  the  flow  of  the  courses,  is  abrupt  exposure  to  cold. 
This  obstruction  is  apt  to  arise  in  going  suddenly  from 
a  warm  room  after  exercise,  and  when  the  pores  are 
open,  into  the  cold  air.  It  is  also  caused  by  plunging 
the  limbs  or  body  into  cold  water  during  the  period. 
Insufficient  clothing  and  thin  shoes  may  also  be  men 
tioned  as  common  causes. 

Violent  emotions  of  the  mind,  vehement  anger,  ter 
ror,  sudden  joy,  intense  grief,  revolting  sights,  and 
electric  shocks,  may  likewise  be  reckoned  as  frequent 
causes  of  obstruction  or  suppression  of  menses  during 
the  period. 

It  has  been  asserted  that  severe  physical  exertion 
often  induces  suppression,  and  the  fact  that  habitual 
dancers  are  subject  to  but  slight  catamenial  dischar 
ges,  has  been  adduced  as  a  proof  of  the  assertion.  We 
are  inclined  to  credit  this  statement,  from  reflecting 
that  operatives  who  labour  long  and  hard,  have  but  a 


510  DISEASES    OF   THE    URINARY 

very  slight  seminal  secretion,  and  consequently  but 
little  inclination  for  sexual  enjoyment ;  while  he  who 
enjoys  his  otium  cum  dignitate,  abounds  in  this  secre 
tion,  and  experiences  frequent  amorous  desires.  The 
same  result  may  happen  to  females,  with  reference  to 
their  monthly  secretion,  and  yet  no  unpleasant  conse 
quences  arise  from  the  diminution  or  suppression  of  the 
discharge,  since  a  sufficient  amount  of  the  vital  stimuli 
has  already  been  expended  in  severe  muscular  exer 
cise. 

Prognosis. — Retention  proceeding  from  a  natural 
lack  of  constitutional  vigour,  is  always  difficult  to 
cure ;  but  where  no  serious  organic  difficulty  exists, 
we  may  generally  hope  for  ultimate  success.  In  cases, 
however,  which  are  complicated  with  chronic  pulmo 
nary  disease,  dropsical  affections,  and  organic  disease 
of  the  heart  or  liver,  the  prognosis  must  always  be  un 
favourable.  Retention  from  imperforated  os  uteri,  or 
hymen,  and  from  vaginal  adhesions  and  polypi,  are  all 
readily  cured  by  surgical  means. 

When  suppression  arises  as  a  symptom  of  some 
chronic  disease,  especially  if  it  has  persisted  for  seve 
ral  months,  we  shall,  for  the  most  part,  find  the  case 
incurable  ;  when,  on  the  contrary,  it  has  arisen  from 
an  acute  disorder,  the  cure  may  be  easily  accom 
plished. 

Obstructions  which  are  consequences  of  anger,  grief, 
fright,  jealousy,  or  exposure  to  wet  and  cold,  may  also 
be  speedily  restored  by  suitable  specifics. 

In  forming  an  opinion  respecting  the  probable  ter 
mination  of  amenorrhcea,  it  should  always  be  borne  in 
mind,  that  it  is  almost  invariably  either  a  symptom  of 
some  other  disease,  or  that  it  owes  its  origin  to  a  ge 
neral  lack  of  constitutional  vigour.  Much,  therefore, 
depends  upon  the  general  condition  of  the  system,  and 
upon  the  curable  or  incurable  nature  of  the  malady 
which  causes  the  menstrual  derangement,  as  to  whe 
ther  our  prognosis  be  favourable  or  otherwise. 

Therapeutics. — In  the  management  of  amenorrhoea, 
our  first  attention  should  always  be  directed  to  the  re 
moval  of  the  cause  upon  which  it  depends.  Those 
cases  of  retarded  menstruation  dependent  upon  a  want 
of  constitutional  vigour,  will  derive  material  benefit 


AND  GENITAL  ORGANS.  511 

from  well  regulated  exercise,  nutritious  diet,  change 
of  scene  and  of  climate,  sea  air,  sea  voyages,  and  bath 
ing.  Retention  from  mechanical  obstructions,  can  on 
ly  be  cured  by  the  aid  of  the  surgeon. 

But  in  suppression  or  obstruction,  unattended  with 
any  serious  local  complication,  and  originating  from 
exposure  to  cold,  mental  emotions,  suddenly  checked 
perspiration,  cold  drinks,  fevers,  &c.,  we  may  afford 
the  most  prompt  relief  by  the  employment  of  suit 
able  remedies. 

We  call  attention  to  the  following  medicines  :  pul- 
satilla,  sabince,  china,  calcarea  carb.,ferrum,  graphites, 
conium,  serpentaria  virg.,  sulphur,  sepia. 

Pulsatilla  is  adapted  to  females  of  a  mild,  timid,  and 
amiable  disposition,  who  are  easily  excited  to  tears  or 
to  laughter.  It  may  be  used  in  cases  where  menstru 
ation  is  delayed  a  few  days  beyond  the  natural  period, 
in  abrupt  suppression  of  the  courses,  from  cold  bath 
ing,  wet  feet,  sudden  suppression  of  perspiration  from 
cold  air,  violent  passions  and  emotions,  and  in  fevers, 
in  alternation  with  other  suitable  medicines.  It  is 
also  valuable  in  partial  obstructions,  accompanied 
with  dyspeptic  and  hysteric  symptoms.  The  general 
indications  are,  lassitude,  weariness  of  the  limbs,  un 
pleasant  arterial  pulsations  in  different  parts  of  the 
body,  congestion,  anxiety,  and  oppression  of  the  chest 
and  heart,  after  exercise,  and  in  the  night  when  in  the 
recumbent  posture :  variable  appetite ;  coldness  of 
the  feet ;  sleeplessness  ;  pains  in  the  back ;  weeping 
mood  ;  vertigo  or  giddiness  ;  colicky  pains  in  the  ab 
domen. 

Sabina  is  only  useful  in  that  irregular  variety  of 
amenorrhoea  in  which  the  menses  appear  too  soon,  and 
too  profusely  for  a  few  hours,  and  are  then  suppressed 
either  temporarily  or  permanently.  The  kind  of 
amenorrhoea  in  which  this  medicine  is  applicable,  is 
for  the  most  part  induced  by  a  hyposthenic  condition  of 
the  uterus. 

China  and  ferrum  are  especially  serviceable  in  re 
tarded  menstruation  dependent  on  constitutional  de 
bility,  whether  natural  or  acquired.  The  general  in 
dications  for  their  use,  are,  pale,  sallow,  or  cachectic 
countenance  ;  emaciation  ;  muscles  soft  and  flabby  ;  ra- 


512  DISEASES    OF    THE    URINARY 

pid  circulation ;  rapid  and  difficult  respiration  after 
exercise  ;  palpitation  of  the  heart,  excited  by  mental 
emotions,  exercise,  or  eating  heartily  ;  lassitude,  de 
bility,  and  general  indisposition  to  think  or  act ;  tran 
sient  pains  in  the  chest,  back,  side,  pelvis,  and  limbs  ; 
swelling  and  pain  in  the  hepatic  region  ;  bitter  taste  ; 
feeble  appetite  ;  impaired  digestion ;  nightly  restless 
ness  ;  leucorrhoea. 

Calcarea  carb.,  sulphur,  graphite,  c.onium,  and  sepia, 
are  indicated  in  the  catamenial  irregularities  of  scrof 
ulous,  rickety,  and  syphilitic  subjects.  The  history  of 
each  case  will  enable  us  to  decide  respecting  the  pre 
cise  nature  of  the  disease  upon  which  the  amenorrhoea 
is  dependent,  and  thus  render  it  easy  to  select  an  anti- 
psoric  which  shall  gradually  remove  the  original  cause 
of  disorder,  and  cure  the  patient.  As  a  general  rule, 
calcarea  carb.  agrees  best  with  young  persons  whose 
menses  appear  too  soon,  while  sulphur,  graphite,  coni- 
um  and  sepia  may  be  exhibited  at  all  ages,  but  for  the 
most  part,  in  cases  of  retarded  and  suppressed  men 
struation. 

Serpentaria  virg. — We  have  often  used  this  medi 
cine  in  suppressed  and  obstructed  menses,  from  cold, 
violent  emotions,  and  the  debility  consequent  on  fe 
vers,  with  marked  success.  A  recent  cure  of  amenor- 
rho3a,  verging  on  chlorosis,  has  also  come  under  my 
observation,  which,  taken  in  connection  with  the  other 
examples  alluded  to,  convince  me  that  it  is  a  specific 
of  much  value  in  disorders  of  this  character. 

As  a  majority  of  the  cases  of  amenorrhoea  have  their 
origin  in  some  inherent  constitutional  vice,  and  are,  iii 
reality,  but  mere  symptoms  of  some  other  affection,  it 
is  of  importance  that  our  attention  be  directed  to  all 
of  the  remote  and  slight  symptoms  which  may  exer 
cise  an  influence  upon  the  economy,  as  well  as  to  the 
more  immediate  and  visible  signs  of  the  malady. 

Administration. — When  the  menstrual  derangement 
has  approached  gradually,  and  is  evidently  a  symp 
tom  of  some  general  disease,  like  scrofula,  chlorosis, 
phthisis  pulmonalis,  dropsy,  or  chronic  hepatitis,  the 
remedies  must  be  selected  with  reference  to  these  mal 
adies,  and  the  same  attenuations  and  repetitions  em 
ployed  as  advised  under  these  different  affections. — 


AND  GENITAL  ORGANS.  513 

As  a  general  rule,  in  these  cases,  we  employ  the  first, 
second,  and  third  attenuations,  and  repeat  the  dose 
but  rarely  ;  but  in  abrupt  obstructions,  occurring  in 
females  of  a  robust  constitution,  from  undue  expo 
sures,  or  over-excitement,  we  make  use  of  the  first  or 
second  attenuations,  and  repeat  every  two,  three,  or 
four  hours  until  wre  are  satisfied  with  the  effect  pro 
duced. 

SECTION    XII. 

DYSMENORRHO3A. PAINFUL    MENSTRUATION. 

Diagnosis. — Painful  menstruation  is  of  most  com 
mon  occurrence  in  females  of  sanguineous  and  robust 
constitutions,  and  of  ardent  and  animated  tempera 
ments.  The  monthly  flux  makes  its  appearance  at 
the  usual  period,  but  generally  in  small  quantity,  often 
.becoming  entirely  suppressed  for  several  hours,  and 
then  reappearing  to  a  greater  or  less  extent,  perhaps 
again  to  be  suppressed.  Females  subject  to  dysme- 
norrhoea,  are  almost  invariably  troubled  with  constipa 
tion,  and  frequent  headaches,  from  rush  of  blood  to 
the  brain,  in  the  interval  between  the  catamenial  pe 
riods. 

The  usual  symptoms  attending  dysmenorrhoea,  are, 
severe  bearing-down  pains  in  the  uterine  region,  sim 
ilar  to  the  pains  of  labour,  and  coming  on  in  parox 
ysms  ;  constant  aching  in  the  small  part  of  the  back, 
the  loins,  the  pelvis,  and  the  limbs  ;  accelerated  ac 
tion  of  the  heart  and  arteries  ;  flushed  cheeks  ;  head 
ache  ;  cutting  and  pressing  pains  in  the  abdomen  ; 
flatulence  ;  spasmodic  sensation  in  the  region  of  the 
stomach;  nausea;  eructations;  oppression  in  the 
chest ;  anxiety  and  irritability ;  scanty  discharge  of 
blood  which  is  not  coagulable,  and  containing  lymph, 
and  shreds  of  a  membranous  structure,  or  clots  of  dark 
blood. 

Causes. — The  chief  causes  of  dysmenorrhcea,  are,  an 
inflamed  condition  of  the  secretory  vessels  of  the  ute 
rus,  an  unnaturally  small  os  tincce,  and  inveterate  con 
stipation.  Of  these  causes,  the  first  is  the  most  com 
mon,  and  occurs  in  females  of  a  full  plethoric  habit, 
of  fancies  easily  excited  to  activity,  who  are  fond  of 
22* 


514  DISEASES    OF    THE    URINARY 

the  pleasures  of  the  table,  of  love,  and  shows,  and  who 
prefer  to  pass  their  time  in  heated  parlours,  or  crowded 
ball-rooms,  rather  than  in  active  exercise  out  of  doors. 
When  we  reflect  upon  the  habits  and  the  mode  of  life 
which   the    customs  of  refined  society  impose    upon 
young  females,  we  shall  no  longer  wonder  that  this 
important  function  of  the  uterus  should  so  often  be 
come  disordered.     The  foolish  mother,   anxious  that 
her   child  should  grow  up  according  to  the   laws   of 
a  false  elegance,  with  a  shape  of  body  moulded  to  suit 
the  code  of  fashion,  rather  than  in  those  once  approved 
proportions  which  the  Creator  gave  her,  envelopes  her 
in  corsets  and  stays,  pressing  the  abdominal  viscera 
downward  upon  the  bladder  and  uterus,  and  the  tho 
racic  organs  upwards   towards  the  throat,  and  thus 
moulds  a  waist  sufficiently  small  and  wasp-like  to  meet 
the  requirements  of  a  sham  gentility.    In  carrying  out 
this  wicked  whalebone  and  buckram  system,  the  im-. 
portant  functions  of  circulation,  respiration,  digestion, 
and  menstruation  are  of  no  sort  of  consequence  to  the 
deluded  victim  or  her  friends,  when  compared  with 
the  imperative  demands  of  fashion.     God  made  the 
human  body  of  precisely  the  right  proportions  for  the 
healthful  exercise  of  all  the  organs  ;  civilized  woman 
baffles    this  ordination  by  mechanical  devices,    and 
makes  of  the  form  an  artificial  thing,  recognised  and 
known  as  a  specimen  of  gentility,  the   functions  of 
which  are  subject  to  continual  derangements,  by  con 
sumption,  chlorosis,  dysmenorrhcea,  amenorrhoea,  con 
stipation,  and  organic  affections  of  the  heart.     After 
the  innocent  young  girl  has  been  thus  cheated,  not  by 
"  dissembling  nature,"  but  by  a  fashionable   mother, 
"  out  of  her  fair  proportions,"  it  is  deemed  necessary, 
in  order  to  complete  her  education,  to  prim  her  up 
within  the  crowded  walls  of  a  boarding-school ;    to 
cram  her  mind  with  some  ten  or  twelve  studies  at  a 
time,  including,  of  course,  music,  and  the  current  lite 
rature  ;  and  to  neglect  active  exercise,  wit,  fun,  mirth, 
and  other  health-promoters,  as  vulgar.     In  this  man 
ner  the  countenance  acquires  that  pale  and  distingue 
cast  so  much  coveted,  and  the  body  that  frail  and  en 
feebled  state  so  common  in  cities. 

Another  cause  which  occasionally  gives  rise  to  pain- 


AND    GENITAL    ORGANS.  515 

ful  menstruation,  is  an  unnaturally  small  os  tincce, 
Dr.  Mackintosh  supposes  this  to  be  a  very  common 
cause  of  dysmenorrhoea,  and  details  numerous  cases 
of  the  kind  which  have  come  under  his  own  observa 
tion.  When  the  painful  symptoms  do  not  yield  read 
ily  to  the  proper  remedies,  an  examination  should  be 
made,  and  if  the  fault  is  in  the  o*  tinea,  our  efforts 
should  be  immediately  directed  to  the  dilatation  of 
the  part  with  bougies. 

The  other  causes  which  should  be  particularly  no 
ticed,  are  collections  of  indurated  faecal  matter  in  the 
colon  and  rectum,  uterine  polypi,  exposure  to  cold, 
and  rheumatic  affections  of  the  uterus. 

Therapeutics. — Abundant  active  exercise  in  the  open 
air,  regular  hours,  a  plain  regimen,  abstinence  from 
wine,  coffee,  and  green  tea,  and  a  temperature  not  ex 
ceeding  68°  Fahr.,  within  doors,  are  prime  conditions 
to  the  successful  treatment  of  dysmenorrho3a.  By  at 
tending  rigidly  to  these  important  points,  constipation 
will  be  obviated,  the  circulation  of  the  blood  equaliz 
ed,  the  animal  heat  uniformly  diffused,  and  all  undue 
determinations  of  blood  prevented.  If,  however,  ob 
stinate  congestions  have  already  set  in,  a  few  doses  of 
a  suitable  specific  will  soon  restore  the  organism  to 
its  normal  condition. 

The  medicines  to  which  we  call  attention,  are  aco 
nite,  pulsatilla,  secale  cornut.,  belladonna,  nux  vom.,pla- 
tina,  f err  urn,  cocculus,  sabina,  conium,  graphite. 

Dysmenorrhosa  arising  from  an  inflammatory  con 
dition  of  the  uterus,  and  attended  \vith  marked  febrile 
symptoms,  quick  pulse,  hot  skin,  thirst,  rapid  respira 
tion,  headache  and  general  restlessness,  demands  the 
employment  of  aconite. 

If  the  menses  are  scanty,  and  accompanied  with 
cutting  pains  in  the  uterine  region,  abdomen,  back, 
and  loins,  vertigo,  loss  of  appetite,  chilliness,  nausea, 
and  discharge  of  thick,  black  blood,  alternating  with 
short  discharges  of  bright  red  blood,  we  may  resort  to 
pulsatilla.  If  the  pains  shift  about  from  one  point  to 
another,  the  indications  are  still  stronger.  Pulsatilla 
also  operates  best  when  the  derangement  has  arisen 
from  fright,  grief,  mortification,  or  from  exposure  to 
wet  and  cold. 


UNIVERSITY  / 

C\f  / 


516  DISEASES    OF    THE    URINARY 

When  the  menstrual  irregularity  proceeds  from 
uterine  congestion,  and  presents  us  with  the  following 
tableau  of  symptoms,  viz.,  violent  spasmodic,  or  bear 
ing-down  pains  from  the  small  of  the  back  to  the  ute 
rus,  with  tenesmus  and  pressure  on  the  bladder  and 
rectum,  coldness  of  the  extremities,  rapid  and  feeble 
pulse,  frequent  and  severe  contractions  of  the  uterus, 
secale  cornutum  should  be  employed. 

Belladonna  is  an  admirable  remedy  when  the  pa 
tient  is  of  a  plethoric  habit  and  sanguine  tempera 
ment,  and  the  disorder  has  originated  from  some 
violent  mental  emotion,  and  is  attended  with  serious 
determination  to  the  brain.  It  may  sometimes  be 
employed  with  advantage  in  alternation  with  aconite. 

Nux  vomica  is  valuable  in  scanty  and  painful  men 
struation,  from  uterine  congestion,  arising  from  scy- 
balous  accumulations  in  the  colon  and  rectum.  The 
pains  are  of  a  spasmodic  character,  and  extend  from 
the  uterus  to  the  neck  of  the  bladder,  and  into  the  ab 
domen.  Considerable  gastric  derangement  usually 
attends  this  variety  of  dysmenorrhoea. 

Platina,  ferrum,  or  sabince,  are  applicable  in  that 
variety  in  which  the  menstrual  discharge  is  sufficient, 
or  even  inordinate  in  quantity,  but  is  attended  with 
severe  bearing-down  pains  in  the  uterine  region,  cut 
ting  pains  in  the  back,  loins,  and  thighs,  pressure  in 
the  groins,  cramps  in  the  abdomen,  blood  dark,  and 
containing  membraneous  shreds,  and  too  frequent  ap 
pearance  of  the  menses. 

For  uterine  and  abdominal  spasms,  nausea,  faint- 
ness,  impeded  respiration,  and  a  scanty  discharge  of 
coagulated  blood,  mixed  with  mucus,  we  may  give 
cocculus  or  conium. 

Graphite  is  an  important  remedy  when  the  menses 
appear  too  late,  and  are  too  scanty.  The  uterine  dis 
charge  is  thick  and  dark,  there  are  severe  labour-like 
pains  in  the  pelvis,  also  cutting  pains  in  the  abdomen, 
small  of  the  back  and  hips,  vertigo,  constipation,  chil 
liness,  cold  hands  and  feet,  flatulence,  and  general 
lassitude  and  debility. 

Administration. — The  medicines  may  be  employed 
at  the  first,  second  and  third  attenuations,  and  repeated 
every  two  hours  during  the  more  severe  symptoms. 


AND  GENITAL  ORGANS.  517 

The  remedy  should  also  be  given  once  in  two  or  three 
days  during  the  intervals  between  the  monthly  epochs. 

SECTION  XIII. 

MENORRHAGIA. UTERINE    HAEMORRHAGE. 

Diagnosis. — Profuse  uterine  haemorrhages  may  take 
place  at  any  period  of  life  from  puberty  to  extreme 
old  age,  and  in  every  variety  of  constitution.  But  the 
most  common  kind  of  menorrhagia  to  which  the  at 
tention  of  the  physician  is  called,  is  that  which  hap 
pens  during  the  monthly  periods,  from  a  congestion 
or  relaxation  of  the  uterine  secretory  vessels.  A  cer 
tain  amount  of  menstrual  fluid  is  secreted  each  month, 
and  this  natural  quantity  is  determined  by  the  temper 
ament,  constitution,  and  habits  of  life  of  each  parti 
cular  subject.  Thus,  robust  and  plethoric  females, 
who  live  richly  and  drink  wine,  may  lose  a  large 
quantity  of  blood  at  each  period,  and  suffer  no  incon 
venience  from  it ;  while  individuals  of  delicate  and  re 
laxed  constitutions,  would  immediately  experience  ill 
effects  from  so  profuse  a  flow.  It  is  when  this 
healthy,  natural  flux  becomes  morbidly  augmented, 
that  we  apply  to  it  the  designation  of  uterine  hcemor- 
rhage,  and  deem  it  necessary  to  employ  medicinal 
means. 

Dangerous  uterine  haemorrhages  often  occur  during 
pregnancy,  from  disturbance  or  rupture  of  the  mem 
branes  or  of  the  placenta,  and  also  from  concussions, 
blows,  violent  exercise,  fright,  anger,  cathartics,  and 
emmenagogues. 

The  symptoms  which  precede  menorrhagia,  occur 
ring  at  the  menstrual  periods,  are,  general  uneasiness 
and  dissatisfaction,  petulancy,  lassitude,  sense  of  ful 
ness  and  oppression  in  the  head,  weariness  and  wan 
dering  pains  in  the  back,  loins,  and  inferior  extre 
mities,  sense  of  weight  and  pressure  in  the  pelvis, 
chilliness,  unnatural  determinations  of  blood,  cold 
feet,  rapid  pulse,  and  impaired  appetite. 

The  symptoms  attendant  on  the  flux,  will  depend 
entirely  upon  the  nature  of  the  case,  the  constitution, 
and  the  amount  of  blood  lost  in  each  instance.  In 
light  cases  of  menorrhagia,  the  patient  only  experi- 


518  DISEASES    OF    THE    URINARY 

ences  a  general  sense  of  lassitude,  debility,  and 
weariness,  faintness,  tired  and  uneasy  sensations  in 
the  back  and  limbs,  indisposition  to  exercise,  a  faint 
and  deathlike  feeling  at  the  pit  of  the  stomach,  pale 
ness  of  the  face,  cold  extremities,  and  feeble  and  un 
satisfactory  respiration. 

In  more  serious  cases  the  patient  becomes  almost 
exsanguineous  ;  the  face,  lips,  and  surface  become 
blanched  ;  the  muscular  strength  entirely  prostrated ; 
every  attempt  to  move  or  converse  induces  immediate 
syncope  ;  there  is  more  or  less  determination  of  blood 
to  the  brain,  as  is  evinced  by  sharp  pains,  delirium, 
ringing  in  the  ears,  and  throbbings  of  the  carotid  and 
temporal  arteries  ;  the  vision  is  impaired,  floats  circu 
late  before  the  eyes,  respiration  is  oppressed,  palpita 
tion  of  the  heart  ensues  from  exercise  or  emotions  ; 
pulse  rapid  and  extremely  feeble  ;  general  coldness  of 
the  surface  ;  great  and  undefinable  uneasiness  and 
nervous  irritation.  The  blood  gushes  upon  every  ex 
ertion  to  change  position,  and  on  coughing,  sneezing, 
or  vomiting.  After  the  patient  has  become  reduced 
by  its  loss  to  a  very  low  state,  frequent  and  pro 
tracted  fainting  turns  come  on  ;  respiration  and  cir 
culation  become  almost  suspended  ;  the  blood  clots  at 
the  mouths  of  the  uterine  vessels,  and  thus  the  flood 
ing  is  temporarily  arrested.  As  soon,  however,  as  the 
organism  reacts,  these  clots  are  liable  to  be  expelled 
by  the  contractile  efforts  of  the  uterus,  and  the  flow 
ing  to  re-appear.  These  different  conditions  may  oc 
cur  several  times  during  the  progress  of  the  disorder, 
until  finally  the  patient  is  so  completely  prostrate, 
that  there  is  no  re-action,  the  clots  are  not  expelled, 
and  time  is  allowed  for  the  uterine  vessels  to  recover 
themselves  sufficiently  to  resist  any  further  morbid 
secretion.  Cases  of  this  description  are  not  uncom 
mon,  and  the  cures  are  often  erroneously  attributed  to 
monstrous  doses  of  opium  and  sugar  of  lead,  rather 
than  to  the  kind  offices  of  nature  in  inducing  syncope, 
and  a  consequent  coagulation  of  the  blood  in  the 
uterus. 

We  have  enumerated  amongst  the  symptoms  of  the 
complaint,  determination  of  blood  to  the  head,  and  in 
flammation  of  the  brain.  These  symptoms  have  been 


AND  GENITAL  ORGANS.  519 

so  often  observed  in  connection  with  profuse  haemor 
rhages,  and  the  question  has  been  so  often  discussed, 
in  regard  to  the  propriety  of  blood-letting  for  the  cure 
of  a  cerebral  inflammation  which  has  been  caused  by 
excessive  loss  of  blood,  that  no  one  will  deny  the  fact, 
that  these  symptoms  actually  occur  as  a  direct  conse 
quence  of  menorrhagia.  Examples  of  this  kind  should 
teach  the  important  truth,  that  excessive  loss  of  blood  is 
always  a  powerful  predisposing  cause,  and  in  very  many 
instances  a  direct  exciting  cause  of  inflammations  of 
the  brain,  lungs,  and  other  structures.  It  ought  also  to 
induce  the  exercise  of  a  little  reason  in  therapeutical 
measures,  rather  than  a  persistence  in  the  empirical 
routine  of  the  old  school,  of  venesection,  opiates,  and 
astringents. 

Menorrhagia  originating  in  organic  derangements 
of  the  uterus,  like  indurations,  cancers,  tumours,  and 
ulcers,  will  be  accompanied  with  the  symptoms  pecu 
liar  to  these  different  maladies,  in  addition  to  their 
ordinary  signs.  Cases  of  this  description  will  require 
careful  attention,  both  in  a  diagnostic  and  in  a  thera 
peutical  point  of  view.  Thus,  if  the  disease  be  de 
pendent  on  a  scrofulous  or  psoric  diathesis,  or  a 
syphilitic  taint,  our  remedies  must  be  directed  as  well 
to  these  original  and  general  causes,  as  to  those  which 
are  more  immediate  and  local.  By  this  means  we 
may  strike  the  silent  and  invisible  enemy,  while  sub 
duing  others  which  are  manifest  to  our  senses. 

Causes. — We  include  among  the  remote  causes  of 
this  affection,  improper  physical  and  moral  education, 
excesses  in  eating  and  drinking ;  insufficient  nutri 
ment  ;  scrofulous,  syphilitic,  or  psoric  taints  ;  pressure 
of  the  abdominal  viscera  downwards  upon  the  uterus, 
by  mechanical  contrivances ;  an  ardent  sanguine 
temperament,  and  a  plethoric  habit,  or  a  lymphatic, 
venous  temperament,  and  a  relaxed  habit. 

The  proximate  causes  are,  irritation,  congestion,  or 
inflammation  of  the  secretory  vessels  of  the  uterus ; 
the  various  disturbances  and  injuries  occurring  during 
pregnancy,  and  from  accouchement,  cancers,  ulcers,  tu 
mours,  indulgence  in  the  pleasures  of  love,  and  of 
stimulating  drinks  during  the  catamenial  period. 

Prognosis, — A  favourable  termination  may  be  ex- 


520  DISEA-SES    OF    THE    URINARY 

pected  when  no  organic  affection  exists,  if  the  patient 
is  moderately  robust,  and  the  disease  depends  upon 
simple  local  inflammation,  or  the  accidents  arising 
from  pregnancy  and  accouchement.  Many  of  the 
floodings,  however,  which  proceed  from  miscarriage, 
from  abnormal  positions  of  the  foetus  and  placenta, 
and  from  accidents  during  delivery,  require  prompt, 
bold,  and  judicious  efforts  on  the  part  of  the  ac 
coucheur  to  rescue  the  patient  from  fatal  prostration. 
But  no  woman  need  bleed  to  death  under  any  of  these 
circumstances,  if  there  is  proper  knowledge  and  de 
cision  on  the  part  of  the  physician. 

The  circumstances  which  must  render  our  prog 
nosis  unfavourable  are,  chronic  induration  or  soften 
ing  of  the  uterus,  cancerous  and  other  incurable  ulcer- 
ations  and  tumours,  and  morbid  growths  within  the 
viscus.  But  even  in  these  apparently  hopeless  cases, 
we  should  never  despair,  for  the  resources  of  homoBO- 
pathy  sometimes  surpass  our  most  sanguine  expecta 
tions. 

Therapeutics. — After  having  removed,  as  far  as  pos 
sible,  all  disturbing  causes,  a  suitable  remedy  may  be 
selected  fromplatina,pulsatilla,belladonna,  ipecacuanha, 
sabina,  secale  cor.,ferrum  met.,  arnica,  china,  chamomela, 
sepia,  bryonia,  nux  vom.,  carbo  animal.,  acid  phns., 
hyoscyamus,  crocus  sat.,  creosote. 

Platina  is  particularly  suited  to  females  of  a  sensi 
tive  and  impressible  organization,  and  who  suffer  from 
too  frequent  and  too  profuse  catemenia.  The  flow  is 
accompanied,  and  occasionally  preceded,  by  cutting 
and  pressing  pains  in  the  abdomen,  back,  and  pelvis ; 
dull  pains  in  the  groin  and  thighs ;  sensation  of  ful 
ness  in  the  uterus ;  chills  alternating  with  flushes  of 
heat ;  unusual  sensitiveness  of  the  genital  organs ; 
headache  ;  sadness  ;  debility  ;  restlessness  ;  leucor- 
rhoea ;  menstrual  discharge  red  and  fluid,  or  dark, 
thick,  and  coming  away  in  clots.  This  remedy  is  ap 
plicable  in  menorrhagia  arising  from  induration  or 
cancer  of  the  womb. 

Pulsatilla  is  useful  in  menorrhagia  occurring  in  fe 
males  at  the  ''turn  of  life,"  or  from  schirrus  uteri,  or 
from  simple  passive  congestion  of  the  uterus,  or  during 
pregnancy  and  accouchement.  The  blood  is  generally 


AND  GENITAL  ORGANS.  521 

dark  and  coagulated,  and  is  expelled  only  at  intervals, 
but  in  large  quantities.  In  profuse  haemorrhages 
after  delivery,  when  the  uterus  does  not  contract, 
and  the  patient  is  much  prostrated  from  pain  and 
loss  of  blood,  pulsatilla  is  an  excellent  remedy.  It 
may  also  be  given  in  menorrhagia  characterized  by 
inconstant  and  shifting  pains  in  the  back,  loins,  abdo 
men  and  pelvis. 

Belladonna  is  our  best  remedy  in  superabundant 
menstruation  proceeding  from  irritation  and  active 
congestion  of  the  uterine  vessels,  and  also  in  uterine 
inflammations  consequent  upon  abortions,  violent 
passions,  or  protracted  continence.  It  is  an  invaluable 
remedy  in  cerebral  inflammations  arising  from  exces 
sive  uterine  haemorrhage. 

The  general  indications  for  belladonna  are,  a  ple 
thoric  habit ;  ardent,  sanguine  temperament ;  frequent 
determination  of  blood  to  the  head  ;  strong  passions  ; 
pressing  pains  in  the  small  of  the  back  and  the  abdo 
men  ;  sense  of  fulness  in  the  uterus  ;  full  and  rather 
rapid  pulse  ;  vertigo  and  pains  in  the  head ;  nausea  ; 
ringing  in  the  ears ;  partial  loss  of  consciousness  ;  in 
flammation  of  the  womb  ;  profuse  discharge  of  bright 
red  blood ;  flushed  cheeks ;  brilliant  and  congested 
eyes  ;  scliirrus  uteri.  Belladonna  has  been  advised  in 
alternation  with  arnica  or  platina,  when  the  pains 
resemble  those  of  labour,  and  there  is  a  profuse  dis 
charge  of  bright  red  blood. 

Ipecacuanha  may  be  exhibited  when  the  catamenia 
appear  every  two  or  three  weeks,  attended  with  pres 
sure  in  the  uterine  region,  and  profuse  discharge  of 
fresh  blood. 

Sabina  is  indicated  in  menorrhagia  during  and  after 
miscarriage,  and  at  the  menstrual  period.  The  flood 
ing  is  accompanied  with  bearing  down  pains  in  the 
abdomen  and  pelvis  ;  abdominal  spasms  ;  pain  in  the 
uterus ;  ardor  urinon.  and  profuse  discharges  of  dark 
and  coagulated  blood,  or  of  fluid  red  blood.  Sabina  is 
especially  useful  in  protracted  uterine  haemorrhages 
arising  from  a  loss  of  tone  in  the  vessels  of  the  uterus, 
whether  from  previous  disease  or  the  weight  and  pres 
sure  of  the  foetus  in  utero. 

Secale  cornutum  is  recommended   in  hemorrhages 


522  DISEASES    OF   THE   URINARY 

arising  from  passive  congestion  of  the  uterus,  cachec 
tic  habit,  and  debility,  and  want  of  tone  in  the  uterus, 
from  difficult  parturition  or  disease.  The  general  in 
dications  are,  pale  face  ;  cold  surface  ;  feeble  pulse  ; 
white  lips  ;  pains  and  tenesmus  in  the  rectum  and 
bladder;  discharge  of  dark  and  offensive  blood,  in 
creased  on  motion,  coughing,  or  sneezing  ;  great  pros 
tration  ;  numbness  ;  spasms ;  humming  in  the  ears ; 
obscuration  of  vision  ;  loss  of  contractive  power  in  the 
uterus. 

Ferrum  met.  is  indicated  in  profuse  haemorrhages 
after  parturition  and  at  the  monthly  epochs.  The  dis 
charge  is  attended  with  spasmodic  and  labour-like 
pains  in  the  loins  and  uterine  region  ;  flushed  cheeks  ; 
hard  and  fall  pulse  ;  hot  skin  ;  headache ;  hot  and 
scanty  urine  ;  constipation  ;  shudderings. 

Arnica  is  our  remedy  in  menorrhagia,  originating 
from  mechanical  injuries  during  pregnancy  or  delivery, 
or  from  blows,  falls,  contusions,  strains,  etc. 

China  is  applicable  in  haemorrhage  proceeding 
from  an  asthenic  condition  of  the  uterus.  It  is  espe 
cially  useful  in  enfeebled  and  cachectic  females,  who 
flow  too  profusely  after  parturition,  from  an  atonic 
condition  of  the  uterus  and  its  non-contraction.  A 
general  appearance  of  debility  and  exhaustion ; 
blanched  countenance ;  discharge  of  serous  or  thick, 
dark,  and  clotted  blood  ;  pale,  sunken  countenance  ; 
restlessness  ;  constant  fainting  turns  ;  soft  and  flabby 
muscles ;  coldness  of  the  extremities  ;  and  rapid  and 
feeble  pulse,  point  to  this  remedy. 

Chamomela  is  adapted  to  bilious  and  nervous  con 
stitutions,  and  may  be  employed  in  menorrhagia,  at 
tended  with  pains  and  pressure  in  the  pelvis ;  ardor 
urinae ;  tearing  pains  in  the  small  of  the  back,  uterus, 
and  legs,  with  frequent  discharges  of  coagulated  blood. 
It  has  also  been  highly  commended  in  uterine  hasmor- 
rhages  occurring  at  the  change  of  life.  Females  of 
an  angry,  violent  and  quarrelsome  disposition  derive 
most  benefit  from  this  drug. 

Sepia  may  be  used  in  cases  proceeding  from  scrofu 
lous  and  schirrous  affections  of  the  uterine  organs. 
It  is  likewise  advised  in  protracted  chronic  cases 


AND  GENITAL  ORGANS.  523 

where  the  system  has  become  much  exhausted  from 
previous  disease  and  suffering. 

Bryonia  agrees  with  bilious  and  choleric  females, 
and  is  commended  in  menorrhagia  attended  with 
stitching  pains  in  the  head,  back,  and  pit  of  the  stom 
ach,  when  stooping,  or  stepping. 

Nux  vo?n.  wrill  apply  in  cases  of  menorrhagia  from 
uterine  congestion,  accompanied  with  spasmodic  pains 
in  the  uterus,  and  a  discharge  of  clots  of  dark  red  blood. 

Carbo  animal,  has  been  successfully  used  in  a  few 
cases  of  moderate  uterine  haemorrhage,  from  chronic 
induration  of  the  uterus. 

Acid  phosph.  is  specific  in  too  profuse  menstruation, 
attended  with  swelling  and  pain  in  the  liver. 

Hyoscyamus  is  specific  in  superabundant  menstrua 
tion  of  hysterical  females,  who  experience  before  and 
during  the  continuance  of  the  flow,  general  spasms, 
convulsive  laughing  or  weeping,  twitching  or  trem 
bling  of  the  limbs,  headache,  and  occasional  delirium. 
The  discharge  is  bright  red. 

Crocus  sat.  corresponds  to  active  or  passive  uterine 
haemorrhages.  It  is  useful  after  miscarriage,  when 
the  discharge  is  very  profuse,  dark,  and  viscid,  and  the 
patient  is  anxious,  feeble,  chilly,  faint,  sick  at  stomach, 
restless,  thirsty,  and  annoyed  with  palpitation  of  the 
heart,  vertigo,  impaired  vision,  vague  pains  in  the 
back  and  pelvis,  and  unpleasant  dreams.  Movement 
and  coughing  increase  the  haemorrhage. 

Kreosote  is  advised  in  passive  uterine  haemorrhages 
originating  in  scirrhous  degenerations  of  the  uterus,  or 
in  general  laxity  of  the  uterine  vessels.  The  menses 
appear  too  early,  are  too  profuse,  and  accompanied 
with  a  leucorrhoeal  or  ichorous  discharge,  which  irri 
tate  the  parts  with  which  it  comes  in  contact. 

Administration. — In  urgent  cases  of  uterine  haemor 
rhage,  we  give  the  first  attenuations,  and  repeat  every 
half-hour  until  medicinal  symptoms  appear,  or  the 
flooding  abates.  In  less  dangerous  cases,  we  repeat 
every  two,  three,  or  four  hours,  so  long  as  is  necessary. 
With  the  internal  remedies,  cold  water  may  be  ap 
plied  to  the  pelvic  region  by  means  of  cloths.  The 
hips  must  be  elevated  and  supported,  while  the  head 
and  shoulders  are  lowered,  and  the  patient  be  kept 
cool,  quiet,  and  free  from  excitement. 


524 


CHAPTER  XXVII. 

DISEASES  OF  THE  FIBROUS  AND  MUSCULAR  SYSTEM. 
SECTION  I. 

ACUTE    RHEUMATISM. 

Diagnosis. — Acute  rheumatism  usually  commences 
after  an  abrupt  suppression  of  perspiration,  in  conse 
quence  of  exposure  to  wet,  cold,  or  to  a  highly  variable 
temperature.  It  first  manifests  itself  in  the  form  of 
slight  chills,  lassitude,  and  general  uneasiness,  which 
are  soon  succeeded  by  swelling,  redness,  pain,  and 
augmented  heat  in  the  part  affected.  The  pains  vary 
much  in  character,  being  sometimes  aching  and  gnaw 
ing,  at  others,  lancinating  and  darting,  or  dull  and 
throbbing,  or  numb,  pungent,  and  prickling,  and  ag 
gravated  by  movement,  by  exposure  to  drafts  of  cold 
air,  and  by  the  pressure,  or  touch  of  the  hand.  In  the 
first  instance,  rheumatism  seizes  upon  the  fibrous  tex 
tures,  but  as  the  inflammatory  action  becomes  devel 
oped,  other  tissues  become  involved,  the  capillaries  of 
the  neighbouring  parts  become  distended  with  red 
blood,  and  the  usual  phenomena  are  present.  The 
larger  joints  are  more  subject  to  rheumatic  inflam 
mation  than  other  parts  of  the  body,  although  it  is  not 
uncommon  for  the  inflammation  to  commence  in  the 
head,  neck,  chest,  arms,  or  legs,  and  gradually  ex 
tend  into  the  neighbouring  joints.  The  more  common 
accompanying  symptoms  of  acute  rheumatism  are, 
bitter  taste  in  the  mouth,  coated  tongue,  rapid  and  full 
pulse,  moderately  hot  skin,  thirst,  scanty,  high-coloured 
and  sedimentitious  urine,  intense  pain  on  moving  the 
affected  part,  anxious  and  distressed  expression  of 
countenance,  and  occasional  perspiration. 

Rheumatic  inflammations  are  liable  to  shift  from 
joint  to  joint,  and  sometimes  to  fix  upon  important  in 
ternal  organs,  like  the  brain  and  its  membranes,  the 
pulmonary  structures,  and  the  heart,  and  its  appen 
dages.  So  long  as  the  malady  confines  itself  to  the 
joints,  or  to  the  external  parts  of  the  body,  it  is  unat- 


DISEASES    OF    THE    FIBROUS,  ETC.  525 

tended  with  danger  to  life  ;  but  when  metastases  occur 
to  important  internal  organs,  the  disease  becomes  in 
an  eminent  degree  perilous. 

Acute  rheumatism  occurs  for  the  most  part,  in  young, 
healthy,  and  robust  subjects,  and  can  be  generally 
traced  to  undue  exposure  to  cold,  or  to  a  wet  and  varia 
ble  atmosphere. 

Chronic  rheumatism  differs  from  the  acute  form  in 
many  respects  ;  as  for  example,  absence  of  febrile 
symptoms  ;  the  fixed  character  of  the  pains  ;  no  per 
ceptible  swelling  or  redness  in  the  affected  parts  ;  the 
pains  sometimes  aggravated,  and  at  other  times  ame 
liorated  by  walking,  and  other  exercises  ;  great  sensi 
bility  of  the  diseased  tissues  to  changes  of  temperature, 
to  humidity,  and  to  cold  ;  dryness  and  inactivity  of 
the  skin  ;  rigidity  in  the  parts,  most  apparent  when 
attempting  to  move,  or  to  walk,  after  having  been 
quiet  for  a  considerable  period  ;  sedimentitious  urine ; 
weakness,  trembling,  or  numbness  of  the  disordered 
parts. 

Therapeutics. — We  enumerate  as  the  principal  reme 
dies,  rhus,  bryonia,  aconite,  colchicumj  belladonna,  pul- 
satilla,  dulcamara,  mercurius,  nux  vomica,  phosphorus, 
calcarea  carbonica,  veratrum,  hepar  sulphur,  arnica, 
colocynth,  lycopodium,  sulphur. 

Rhus  tox. — External  indications. — The  integuments 
about  the  joints  swollen  and  red  ;  surface  of  the  body 
hot  and  moist  ;  tongue  dry  and  red ;  pulse  frequent, 
and  hard  ;  urine  dark,  or  red,  and  turbid. 

Physical  sensations. — Drawing  and  tearing,  or  ten 
sive  stinging  and  dragging  pains  in  the  affected  parts, 
increased  by  exposure  to  cold,  by  rest,  and  by  move 
ment  after  having  been  for  some  time  quiet  ;  rigidity, 
lameness,  and  weakness  of  the  muscles  in  the  vicinity 
of  the  diseased  textures  ;  increase  of  the  febrile  symp 
toms,  and  of  the  pains,  at  night,  in  bed  ;  perspiration, 
especially  during  the  pains  ;  pains  alleviated  by  ex 
ercise  ;  throbbing,  and  burning  in  the  knees,  or  ancles  ; 
painful  involuntary  contractions  of  the  muscles  of  the 
calves  of  the  legs  ;  chronic  rheumatic  pains  occurring 
early  in  the  morning,  and  disappearing  on  moving 
about. 


526  DISEASES    OF    THE    FIBROUS 

Mental  and  moral  symptoms. — Intellect  unimpaired ; 
disposition  irritable  and  impatient. 

Administration. — One  drop  of  the  first  dilution  may 
be  given  in  a  dessert  spoonful  of  water,  every  two  or 
three  hours,  until  the  pains  begin  to  subside,  or  until 
a  medicinal  action  is  produced  upon  the  inflamed  tis 
sue. 

Bryonia. — External  indications. — Swelling  and  red 
ness  of  the  inflamed  textures  ;  countenance  pale  or 
sallow,  or  flushed  and  hot  ;  tongue  covered  with  a 
white  or  yellow  fur  ;  hot  and  dry  surface,  or  perspi 
ration  of  an  acid  character  after  exercise  ;  considerable 
thirst,  frequent  and  soft  pulse  ;  red  or  yellowish  urine; 
position  such  as  to  relax  the  muscles  bearing  upon 
the  diseased  parts. 

Physical  sensations. — Pains  of  a  tearing,  throbbing, 
or  lancinating  character,  aggravated  by  movement,  by 
the  touch,  by  the  contact  of  cold  air,  and  by  eating  ; 
a  relaxed  state  of  the  muscles,  and  perfect  rest,  affords 
almost  entire  relief  from  suffering ;  bitter  taste,  or 
dryness  of  the  mouth,  with  thirst  ;  nausea  ;  bilious 
vomiting  ;  severe  pulsating  headache  ;  morbid  sensi 
bility  of  the  whole  surface  to  the  touch  ;  stitching 
pains  in  the  region  of  the  liver,  and  in  the  intercostal 
muscles  ;  symptoms  worse  during  the  night. 

Mental  and  moral  symptoms. — General  uneasiness, 
anxiety,  and  irritability  ;  sleeplessness. 

Administration. — The  second  or  third  dilution  may 
be  employed — a  dose  every  two,  three,  or  four  hours, 
as  the  symptoms  appear  to  require.  For  the  active 
febrile  symptoms  which  occasionally  accompany  the 
affection,  we  are  in  the  habit  of  prescribing  aconite 
and  bnjonia  in  alternation,  with  satisfactory  results. 

Colchicum  is  a  valuable  remedy  in  both  acute  and 
chronic  rheumatism.  The  pains  are  lancinating, 
jerking,  or  tearing,  worse  in  the  night,  and  increased 
by  care,  anxiety,  or  movement :  or,  there  may  be  only 
stiffness  and  lameness  in  the  joints,  when  attempting 
to  walk,  with  oadematous  swellings  of  the  parts  in  the 
vicinity  of  the  inflammation.  Dr.  Schroen  commends 
colchicum  in  those  cases  which  resist  the  clearly  indi 
cated  medicines,  provided  the  skin  is  moist,  and  the 
urine  is  turbid.  Dr.  S.  advises  it  to  be  given  in  the 


AMD    MUSCULAR    SYSTEM.  527 

form  of  vini  seminis  colchici,  and  in  doses  of  twelve 
drops  daily.  We  have  found  a  single  drop  of  the  first 
dilution,  repeated  once  in  from  three  to  six  hours,  ac 
cording  to  the  acute  or  chronic  nature  of  the  case, 
very  efficacious,  in  several  obstinate  cases  which  had 
resisted  the  action  of  other  medicines. 

Belladonna  will  prove  an  excellent  remedy,  in  rheuma 
tic  attacks  accompanied  with  a  high  degree  of  nervous 
irritability,  and  a  morbid  activity  of  the  cerebral  or 
gans.  The  pains  are  very  severe,  especially  at  night, 
increased  by  touch,  or  by  remaining  too  long  in  one 
position. 

Pulsatilla  is  indicated  when  the  pains  shift  rapidly 
from  one  part  to  another,  and  are  unattended  with 
any  great  swelling  or  redness  of  the  integuments  ;  al 
so,  in  chronic  rheumatism  characterized  by  weakness, 
rigidity,  coldness,  and  sensation  of  weight  in  the  dis 
ordered  structures. 

Dulcamara  often  proves  speedily  curative  in  rheu 
matic  inflammations  which  have  been  caused  by  ex 
posure  to  cold  and  dampness.  The  affected  parts  usu 
ally  feel  as  if  bruised  or  beaten,  and  after  remaining 
for  some  time  in  one  position,  are  attacked  with  se 
vere  pains  which  do  not  subside  until  the  patient 
moves  about.  The  pains  are  most  common  in  the 
back,  and  in  the  joints  of  the  arms  and  legs. 

In  cases  of  frequently  recurring  rheumatism,  of 
scrofulous  or  psoric  subjects,  we  must  use  one  or 
more  of  the  following  medicines :  calcarea  carbonica, 
sulphur,  lycopodium,  mercurius. 

When  the  disease  has  become  chronic  and  invete 
rate,  and  abnormal  depositions  occur  about  the  joints, 
with  thickening  of  the  membraneous  tissues,  and  per 
manent  rigidity,  weakness,  and  tenderness  on  motion, 
a  persevering  employment  of  rhus,  or  hepar  sulphur, 
or  mix,  or  phosphorus,  or  veratrum,  or  lachesis,  will  in 
duce  curative  results  of  the  most  satisfactory  charac 
ter. 

Other  medicines  which  have  occasionally  proved 
successful  in  rheumatic  affections,  are,  colocynth,  io 
dine,  ferrum,  china,  arsenicum,  arnica,  carbo  vegetabilis, 
and  hyoscyamus. 

Administration. — In  the  acute  form  of  the  malady, 


528  DISEASES    OF    THE    FIBROUS 

we  employ  from  the  third  to  the  sixth  attenuations, 
and  repeat  the  doses  every  two  hours  until  a  medicinal 
impression  is  evident.  In  chronic  rheumatism,  we 
prefer  the  first  attenuation,  and  prescribe  a  dose  once 
or  twice  daily. 

SECTION   II. 

ARTHRITIS. GOUT. 

Although  rheumatism  and  gout  are  described  by 
authors  as  different  diseases,  it  is  altogether  probable 
that  the  nature  of  the  inflammatory  action  is  the  same 
in  both  instances.  When  this  peculiar  inflammation 
seizes  upon  the  young  and  robust,  and  pervades  the 
larger  joints  and  the  muscular  structures,  it  receives 
the  name  of  rheumatism  ;  but  when  individuals  ad 
vanced  in  life,  are  the  subjects  of  attack,  and  it  ap 
pears  in  the  small  joints,  it  is  recognised  as  gout. 

A  fit  of  the  gout  is  almost  always  preceded  by  some 
gastric  or  intestinal  derangement,  like  impaired  appe 
tite,  furred  tongue,  bitter  taste,  acid  or  bitter  eructa 
tions,  flatulent  distention  of  the  stomach  and  intestines, 
and  occasionally  diarrhrea.  The  inflammation  is,  for 
the  most  part,  situated  in  the  ball  of  the  great  toe,  but 
it  may  attack  any  of  the  smaller  joints,  and  as  the  dis 
ease  advances,  the  veins  in  the  vicinity  of  the  pain 
become  distended ;  the  integuments  swollen,  cedema- 
tous,  arid  of  a  bright  scarlet  colour  ;  the  pains  become 
severe,  of  a  darting,  throbbing,  or  a  persistent  ach 
ing  and  burning  character,  increased  by  contact  or  by 
movement ;  there  is  an  almost  entire  loss  of  muscular 
power  of  the  affected  parts  ;  the  pains  are  worse  du 
ring  the  night,  and  accompanied  during  this  period  by 
active  febrile  symptoms  ;  nearly  all  the  functions  of 
the  organism  are  sympathetically  deranged  ;  the  urine 
is  small  in  quantity,  high  coloured,  and  becomes  tur 
bid  on  standing ;  the  patient  is  restless,  irritable,  and 
morbidly  sensitive  to  moral  and  physical  impressions. 
The  disorder  usually  arrives  at  its  maximum  of  inten 
sity,  in  two  or  three  days  from  the  commencement  of 
the  inflammation.  At  this  period,  the  whole  toe,  and 
sometimes  the  foot  itself,  become  oedematous,  and  the 
numbness  and  prickling  are  frequently  experienced  in 


AND    MUSCULAR    SVSTBM. 

the  swollen  textures,  especially  during  the  day :  the 
pains  and  the  nightly  febrile  exacerbations,  now  com 
mence  subsiding,  until  at  the  end  of  from  seven  to  ten 
days,  the  active  inflammatory  symptoms  have  disap 
peared  and  left  the  patient  with  a  debilitated  and 
cedematous  limb. 

When  the  paroxysms  of  acute  gout  occur  very  fre 
quently,  they  serve,  after  a  time,  to  impair  the  consti 
tution,  to  cause  permanent  thickenings  of  the  articu 
lar  membranes,  or  cretaceous  deposits  about  the  joints, 
and  to  induce  that  condition  of  the  parts  which  leads 
to  chronic  gout.  This  form  of  the  complaint  is  cha 
racterized  by  dull,  burning,  or  tensive  pains,  oedema, 
thickening  of  the  membranes  of  the  affected  joint, 
with  rigidity,  weakness,  and  partial  loss  of  muscular 
power  ;  more  or  less  gastric  derangement,  augmented 
sensibility  of  the  mind  and  body  to  external  impres 
sions,  depression  of  spirits,  and  general  restlessness 
and  irritability. 

Causes. — Gout  is  generally  supposed  to  be  heredi 
tary,  although  cases  are  constantly  occurring  in  which 
no  natural  predisposition  can  be  traced.  There  is  no 
doubt,  however,  that  in  the  majority  of  instances,  an 
hereditary  predisposition  exists.  The  exciting  causes 
of  gout,  are,  high-living,  want  of  sufficient  exercise, 
abuse  of  stimulants,  especially  wines,  and  general  ir 
ritability  of  the  nervous  system,  from  loss  of  rest,  and 
irregularity  in  eating. 

Therapeutics. — The  principal  remedies  for  acute  gout, 
are,  bryonia,  nux  vomica,  colchicum,  bell.,  aconite,  rhus, 
pulsatilla,  actcea  spicata,  actcca  racemosa,  guaiacum,  ar 
nica,  arsenicum,,  china,  ledum,  sabince,  cantharides.  For 
chronic  gout,  the  best  remedies  are,  calcarea  carbonica, 
sulphur,  phosphoric  acid,  aururn  muriate,  iodine,  hepar 
sulphur,  phosphorus,  mercurius,  sepia,  silicea. 

It  will  very  commonly  happen  that  several  of  these 
medicines  will  cover  most  of  the  manifest  symptoms 
which  are  usually  present  in  gout,  but  in  making  our 
selection,  the  strictest  regard  should  be  had  to  all  re 
mote  and  exciting  causes  which  may  have  exercised 
an  influence  in  originating  the  malady,  in  order  that 
we  may  strike  deeply  at  the  foundation  of  the  disturb- 

23 


530  HYDROPS. DROPSY. 

ance,  as  well  as  at  the  more  immediate  and  visible 
phenomena. 

In  prescribing  for  gout,  we  may  be  governed  by  the 
general  indications  for  the  different  medicines,  as 
pointed  out  in  the  last  section. 


CHAPTER  XXVIII. 

HYDRO  PS. —  DROPSY. 

SECTION  I. 

General  description. — Dropsy  is  generally  but  a  mere 
symptom  of  some  other  affection.  Its  proximate  cause 
consists  in  an  inflammation,  congestion,  or  exalted 
action  of  the  capillary  extremities  of  the  arterial  ves 
sels  of  the  serous  and  cellular  membranes,,  and  a  tor 
por  or  inactivity  of  the  venous  absorbents  of  the  same 
parts. 

The  remote  and  general  causes  of  dropsy  are,  exces 
sive  loss  of  blood,  and  other  animal  fluids ;  general 
debility  resulting  from  disease,  mechanical  injuries, 
obstructions  of  the  liver,  spleen,  kidneys,  veins,  lungs; 
abuse  of  drugs  and  stimulating  drinks.  At  first  view, 
an  inflammation  or  congestion  of  the  serous  exha- 
lents,  would  seem  to  be  incompatible  with  general 
debility,  arising  from  excessive  loss  of  blood,  and  dis 
eases  of  the  liver,  kidneys,  lungs,  spleen,  &c.,  but  the 
fact  is  now  well  established,  that  these  circumstances 
actually  favour  the  formation  of  these  very  capillary 
inflammations  and  congestions. 

Some  writers  maintain  that  serous  effusions  do  not 
occur  until  the  active  inflammatory  symptoms  are  pass 
ing  off,  and  a  state  of  sub-acute  inflammation  obtains ; 
while  others,  like  Laennec,  and  Johnson,  lay  it  down 
as  a  fundamental  law  of  serous  membranes,  "  that 
they  begin  to  effuse  the  moment  they  become  in 
flamed."  It  is  true  that  acute  inflammations  of  serous 
membranes  often  occur  and  subside  without  leaving 
any  traces  of  effusion,  but  this  is  owing  to  the  fact, 


HVTDROPS. DROPSY.  531 

that,  during  the  general  febrile  excitement,  the  venous 
absorbents  of  the  affected  cavities,  being  equally 
irritated  with  the  exhalents,  exercise  their  functions 
with  preternatural  activity,  thus  conveying  off  the 
fluid  as  fast  as  exhaled,  and  securing  the  equilibrium 
between  exhalation  and  absorption.  After  the  inflam 
matory  symptoms  have  subsided,  if  the  exhalents  and 
absorbents  both  recover  their  tone,  health  returns ; 
but,  as  frequently  happens,  if  the  latter  remain  feeble,, 
while  the  former  return  to  their  normal  state,  the 
healthy  balance  is  lost,  and  dropsy  is  the  result. 

In  health,  "  the  cellular  tissue  and  all  of  those  cavi 
ties  lined  by  serous  membranes,  are  continually  lubri 
cated  by  a  fluid  which  exhales  from  the  capillary  ex 
tremities  of  the  arterial  vessels." — (Frank.}  This 
fluid  serves  to  render  the  parts  soft,  pliable,  and  mo 
bile,  and  to  prevent  the  adhesive  inflammation  which 
would  otherwise  occur  from  friction  during  the  move 
ments  of  the  body.  These  exhalents  give  out  nearly  a 
given  quantity  of  vapour,  and  a  due  equilibrium  is 
established  between  the  amount  secreted  for  the  use 
of  the  organism,  and  that  which  is  afterwards  taken 
up  by  the  venous  extremities,  and  thrown  off  by  the 
skin,  kidneys,  salivary  glands  and  intestines.  So  long 
as  this  proportion  is  maintained,  all  goes  on  well  ;  but 
whenever  any  of  the  serous  membranes,  like  the  peri 
toneum,  the  pleura,  the  pericardium,  or  the  arachnoid, 
secrete  more  fluid  than  is  required  for  the  wants  of  the 
economy,  or  than  can  be  absorbed  by  the  venous  ex 
tremities,  then  drafts  are  made  upon  other  and  healthy 
parts  to  supply  the  increased  demand.  On  this  ac 
count  the  perspiration  becomes  suppressed,  and  the 
skin  dry  and  husky,  the  saliva  scanty  and  viscid,  the 
urinary  secretions  small,  high-coloured,  fetid,  and  sed- 
imentitious,  the  stools  scanty  and  difficult,  and  the 
functions  generally  deranged. 

In  cases  of  dropsy  arising  from  excessive  loss  of 
blood  or  starvation,  the  normal  physical  condition  of 
this  fluid  is  changed, — the  impression  it  produces  upon 
the  structures  is  altered,  and  a  superabundance  of 
serum  is  poured  out  into  the  cavities  and  the  cellular 
tissue.  This  increased  exhalation  may  be  due  either 
to  the  greater  affinity  which  the  serous  membranes 


532  HYDROPS. DROPSY. 

exert  upon  the  altered  blood,  or  to  an  irritation  of  the 
capillary  extremities  which  induces  an  exaltation  of 
their  exhaling  function.  The  experiments  of  Mat- 
teucci  teach  us,  that  different  fluids  pass  through  the 
animal  membranes  in  definite  quantities  and  with 
certain  degrees  of  rapidity,  according  to  the  char 
acter  of  the  fluids  used  and  the  condition  of  the  tissue 
operated  upon.  These  different  phenomena  are  termed 
endosmose  and  exosmose,  and  it  is  by  no  means  im 
probable  that  some  varieties  of  dropsy  may  be  par 
tially  dependent  upon  this  peculiar  action. 

Another  very  important  circumstance  connected 
with  the  formation  of  dropsies,  is  alluded  to  by  Eberle, 
in  his  Practice  of  Medicine,  viz.,  "I  have  already 
observed,  that  immediately  after  a  profuse  loss  of 
blood,  absorption  goes  on  with  unusual  activity. 
The  blood-vessels  are  rapidly  replenished  with  crude 
fluids ;  for  the  absorbents  being  extremely  active, 
nearly  all  .the  aqueous  fluids,  received  into  the  stom 
ach,  are  speedily  absorbed  into  the  circulation  ;  and 
this  is  especially  favoured  by  the  very  great  thirst 
which  almost  always  occurs  after  excessive  sanguine 
ous  losses.  The  blood  being  thus  inordinately  supplied 
with  a  crude  and  watery  fluid,  becomes  more  irritating 
to  the  heart  and  capillaries,  and  diluted  to  such  a  degree 
as  to  pass  off  more  rapidly  by  the  exhalents."  Direct 
experiments  on  animals  have  proved  that  artificial 
dropsies  may  be  produced,  by  abstracting  blood,  and 
drenching  them  with  water.  On  the  other  hand,  Ma- 
jendie  and  Matteucci  have  equally  demonstrated,  that  a 
fulness  of  the  blood-vessels  very  materially  retards,  and 
in  some  instances,  entirely  suppresses  the  function  of 
absorption. 

We  think,  then,  it  may  be  safely  concluded,  that 
in  every  case  of  dropsy,  there  are  two  simulta 
neous  morbid  conditions  present,  namely,  increased 
exhalation,  and  decreased  absorption,  and  that,  although 
irritation  and  congestion  of  the  exhalents  are  generally 
indispensable  conditions  to  this  morbid  action,  yet  that 
effusion  may  result  in  certain  cases  simply  from  an 
alteration  in  the  character  and  quantity  of  the  blood, 
by  endosmose. 

Dropsies  are  acute  or  chronic,  primitive  or  seconda- 


HVDROPS. DROPSY.  533 

ry,  simple  or  complicated  ;  and  the  character  of  the 
effusion  is  dependent  upon  the  age,  sex,  and  constitu 
tion  of  the  patient,  and  the  nature  of  each  particular 
case.  Generally,  however,  the  fluid  is  composed  of 
albuminous  matter  dissolved  in  more  or  less  water, 
with  different  phosphates  and  carbonates  and  a  little 
sulphur,  (Frank,)  of  an  oily  character,  of  a  citron, 
orange,  or  straw  colour,  and  of  a  consistency  semi- 
gelatinous,  or  like  the  white  of  eggs.  But  these  ap 
pearances  are  sometimes  subject  to  variations,  as  cases 
are  reported  in  which  the  liquid  was  brown,  white, 
green,  purulent,  bloody,  saccharine,  urinous,  and  in 
some  instances  containing  substances  like  hydatids, 
and  bits  of  membrane. 

Much  light  is  sometimes  thrown  upon  the  nature 
and  causes  of  dropsy,  by  an  examination  of  the  urine. 
In  certain  cases  of  anasarca,  for  example,  it  is  found 
that  the  urine  coagulates  on  the  application  of  heat, 
and  from  this  circumstance  we  may  suspect  the  exist 
ence  of  the  disease  so  ably  described  by  Dr.  Bright, 
under  the  name  of  granulated  kidney.  The  application 
of  heat  in  these  cases,  first  causes  the  urme  to  become 
milky,  and  afterwards  to  present  a  curdled,  or  flaky 
appearance.  "In  hydrothorax  following  scarlatina, 
the  urine  is  mixed  with  cruorine  ;  in  hydrothorax  de 
pending  upon  degeneration  of  the  spleen  and  liver,  the 
urine  contains  a  large  quanity  of  urea  and  uric  acid, 
rosic  acid  and  purpurate." — (Hartmann.)  In  other 
instances  we  find  the  urine  loaded  with  albumen. 

In  acute  dropsies  the  effusion  does  not  occur  until 
the  active  inflammatory  symptoms  are  passing  off, 
and  a  condition  of  sub-acute  inflammation  supervenes. 
In  these  cases,  also,  the  exhalation  takes  place  with 
more  rapidity,  and  is  attended  with  more  painful 
symptoms,  than  in  the  chronic  varieties.  Now  and 
then  slight  accumulations  take  place,  which  remain 
stationary  for  years,  when  they  entirely  disappear,  or 
the  morbid  condition  of  the  exhalants  returns,  and  the 
disease  advances  to  its  full  development.  Instances  of 
this  description  are  often  observed  in  hydrocele,  and 
in  ovarian  dropsy. 

An  excellent  diagnostic  arrangement  of  the  dropsies 


534  HYDROPS. DROPSY. 

has  been  made  by  Marshall  Hall,  founded  upon  their 
causes,  viz : 

"  1. INFLAMMATORY  DROPSY. 

"  First. .  The  history. — This  form  of  dropsy  generally 
takes  place  rather  suddenly,  and  is  to  be  traced  to 
exposure  to  wet  and  cold." 

"  Second.  The  symptoms  consist  in  the  appearance 
of  diffuse,  tense  anasarca,  generally  with  dyspnoea, 
and  frequently  with  the  signs  of  effusion  into  the  head, 
thorax,  or  abdomen,  and  with  a  coagulable  and  oc 
casionally  a  sanguineous  condition  of  the  urine," 

"  Third.  The  morbid  anatomy  varies  according  as  the 
dropsy  is  confined  to  the  cellular  membrane,  or  ex 
tended  to  the  serous  membranes ;  in  the  latter  case  there 
is  frequently  the  effusion  of  coagulable  lymph,  as  well 
as  of  serum,  from  the  serous  surfaces.  The  kidney, 
in  protracted  cases,  becomes  disorganized,  granular, 
scabrous,  etc." 

"  2. EXANTHEMATOUS  DROPSY. 

*'  First.  .T^e  history. — This  form  of  dropsy  succeeds 
to  some  exanthematous  diseases,  but  by  far  most  fre 
quently  to  scarlatina" 

"  Second.  The  symptoms  are  similar  to  those  just  de 
tailed  as  designating  inflammatory  dropsy  ;  there  is  the 
same  disposition  to  effusions  into  the  brain,  thorax 
and  abdomen." 

"  3. DROPSY    FROM    EXHAUSTION. 

"  First.  The  history  and  symptoms.  — This  form  of 
dropsy  is  known  by  being  traced  to  the  loss  of  blood. 
It  occurs  in  the  form  of  anasarca,  and  of  effusion  into 
the  cavities.  I  do  not  know  whether  the  urine  be 
coagulable." 

"  Second.  A  similar  form  of  dropsy  is  induced  in 
cases  of  neglected  chlorosis." 

"4. DROPSY    FROM    DEBILITY. 

"  First.  The  history  and  symptoms  sufficiently  estab 
lish  and  distinguish  this  form  of  dropsy.  The  patient 
has  frequently  had  returns  of  dropsical  affection,  and 


HYDROPS. DROPSY.  535 

has  a   pale  and  cachectic   appearance.     The    urine 
coagulates  into  brownish  flakes  by  exposure  to  heat." 

"  5. DROPSY  FROM  OBSTRUCTION  IN  THE  FLOW 

OF  VENOUS  BLOOD. 

"  This  form  of  dropsy  arises  from — 

"  First.  Disease  of  the  heart,  especially  of  the  valves" 

"  Second.  Disease  of  the  lungs." 

"  Third.  Disease  of  the  liver,  especially  the  '  cirrhose.'  " 

"  Fourth.  Pressure,  or  disease,  of  the  veins  them 
selves" 

"  The  history  and  symptoms. — This  kind  of  dropsy  is 
distinguished  by  ascertaining  the  seat  and  nature  of  the 
original  disease.  Like  the  rest,  it  assumes  the  form  of 
anasarca,  and  of  effusion  into  the  serous  cavities,  and 
into  the  cellular  membrane  of  the  internal  organs,  as 
the  lungs,  intestines,  &c.  The  urine  is  not  coagulable" 

"6. DROPSY    FROM    DISEASE    OF    THE    KIDNEYS. 

"  For  the  detection  of  this  species  of  dropsy,  the 
profession  and  mankind  are  indebted  to  Dr.  Bright." 

"  First.  The  symptoms. — It  is  distinguished  by  the 
coagulable  condition  of  the  urine.  The  urine  is  apt 
sometimes  to  be  sanguineous." 

"  Second.  The  complications. — There  is,  in  this  kind 
of  dropsy,  occasionally — 

"  First.  An  attack  of  apoplexy  ;  and  frequently, 

"  Second.  Inflammation  of  the  serous  membranes,  and 
especially  of  the  pleura." 

"  The  liver  is  usually  found  free  from  disease. 

"  The  morbid  anatomy. — Dr.  Bright  describes  three 
kinds  of  this  disease  of  the  kidney.  In  the  first,  the 
kidney  loses  its  usual  firmness,  and  becomes  of  a  yel 
low  mottled  appearance  externally.  The  size  of  the 
kidney  is  not  materially  altered.  In  the  second,  the 
whole  cortical  part  is  converted  into  a  granulated  tex 
ture,  and  there  appears  to  be  a  copious  morbid  inter 
stitial  deposit  of  an  opaque  white  substance.  The 
kidney  is  generally  rather  larger  than  natural.  In  the 
third,  the  kidney  is  rough  and  scabrous  externally,  and 
rises  in  numerous  projections  not  much  exceeding  a 
large  pin's  head,  yellow,  red,  and  purplish  ;  it  is  hard 
and  inclined  to  be  tabulated,  and  its  texture  approaches 


536  HYDROPS. DROPSY. 

to  a  semi-cartilaginous  firmness  ;  there  appears,  in 
short,  a  contraction  of  every  part  of  the  organ,  with 
less  interstitial  deposite  than  in  the  last  variety." 

General  diagnosis. — The  symptoms  most  commonly 
observed  in  dropsy  are,  sensation  of  weight,  oppression, 
fulness,  and  uneasiness  in  the  part  affected,  with  more 
or  less  disturbance  of  the  neighbouring  tissues ;  dys 
pnoea  and  sense  of  suffocation  after  attaining  the  hori 
zontal  posture,  and  after  active  exercise  ;  general 
feeling  of  debility,  and  disinclination  to  bodily  or  men 
tal  exertion ;  partial,  and  in  some  instances,  almost 
total  suppression  of  the  urinary,  salivary,  and  perspi 
ratory  secretions  ;  impaired  appetite  ;  feeble  digestion  ; 
rare  and  scanty  alvine  discharges  ;  thirst ;  countenance 
pale,  sallow,  or  cachectic  ;  emaciation  ;  **  diminution 
of  animal  heat,  sensation,  and  motion,"  (Frank,)  gen 
eral  derangement  of  nearly  all  the  functions. 

In  cellular  dropsy,  the  affected  part  is  swollen,  the 
skin  presents  a  smooth  and  shining  appearance,  with 
blue  veins  traversing  it  in  different  directions,  and  pres 
sure  with  the  finger  causes  a  deep  indentation  or  pit, 
which  remains  for  a  considerable  time.  There  is  also 
an  apparent  diminution  in  the  temperature  of  the  part, 
and  a  sensation  of  weight  and  tension  is  experienced, 
rather  than  of  acute  pain.  The  accumulation  of 
serum  becomes  so  great  in  some  instances  as  to  burst 
through  the  integuments,  and  thus  partially  discharge 
itself. 

In  acute  dropsies  of  the  serous  membranes,  the  symp 
toms  are  more  active.  Here  we  have  general  febrile 
disturbance  ;  acute  tenderness  and  pain  in  the  disor 
dered  part,  especially  on  pressure,  or  contact  of  light 
clothing  ;  urgent  thirst ;  hot  and  dry  skin  ;  urine  very 
scanty  and  high-coloured ;  saliva  viscid,  tenacious, 
and  small  in  quantity  ;  loss  of  appetite  ;  furred  tongue  ; 
rapid  sinking  of  the  physical  energies.  These  acute 
symptoms  often  subside,  and  leave  the  inflamed  mem 
brane  in  a  state  of  sub- acute  inflammation,  thus  de 
veloping  a  well-pronounced  chronic  dropsy. 

It  will  be  observed  in  our  previous  description  of 
symptoms,  that  we  have  included  a  diminution  of  the 
urinary,  salivary,  and  intestinal  secretions,  as  charac 
teristic  of  this  malady  :  but  these  signs  are  not  inva- 


HYDROPS. DROPSY.  537 

riably  present,  for  in  a  few  instances  we  have  wit 
nessed  an  abundant  and  natural  urinary  and  salivary 
secretion  during  the  continuance  of  the  complaint. 
So,  also,  one  or  more  of  the  other  symptoms  described 
may  be  wanting,  and  yet  the  dropsical  affection  pro 
ceed  to  a  fatal  termination  ;  but  these  circumstances 
are  rather  to  be  looked  upon  in  the  light  of  exceptions, 
than  as  general  occurrences. 

Prognosis. — Our  prognosis  must  depend  much  upon 
the  cause  and  nature  of  each  particular  case.  Simple 
cellular  or  serous  dropsies,  uncomplicated  with  disor 
ganization  of  any  of  the  important  organs,  are,  for  the 
most  part,  curable.  In  this  class  we  may  rank  exan- 
thematous  dropsies,  and  those  which  have  arisen  from 
loss  of  blood,  from  acute  diseases  in  which  no  serious 
organic  derangement  has  occurred,  and  from  abuse  of 
mercury  and  other  drugs.  In  these  cases,  a  speedy 
removal  of  the  causes  which  have  conduced  to  the 
disease,  with  pure  air,  a  generous  diet,  and  a  judicious 
course  of  homoeopathic  medicines,  will  generally  ena 
ble  us  to  remove  permanently  the  morbid  accumulation. 

On  the  contrary,  if  the  effusion  has  arisen  from  an 
organic  affection  of  a  vital  organ,  like  the  heart,  the 
liver,  the  lungs,  the  kidney,  or  from  incurable  obstruc 
tion  in  the  veins,  our  prognosis  must  be  unfavourable. 
In  these  cases  of  complicated  dropsy,  our  remedial  ef 
forts  must  be  adapted  to  the  remote  general  disease, 
as  well  as  to  the  immediate  symptoms  of  the  malady. 
Although  the  chances  of  cure  are  small  in  cases  of  this 
description,  yet,  as  recoveries  do  occasionally  take 
place  in  individuals  of  naturally  vigorous  constitu 
tions,  and  in  those  who  are  tenacious  of  life,  we  should 
never  prostrate  our  patients  by  discouragement  and  a 
grim  visage,  but  constantly  point  them  to  a  beacon  of 
hope  in  the  dim  distance  By  this  means,  we  secure 
a  powerful  auxiliary  to  co-operate  \vith  us  in  our 
efforts  to  bring  about  those  changes  in  the  organism 
which  may  lead  to  a  cure. 

We  come  now  to  treat  of  the  different  species  of 
dropsy,  viz.  : 

First.  Anasarca.  Second.  Ascites. 

Third.  Hydro  thorax.         Fourth.  Hydrocephalus, 

Fifth.   Ovarian  dropsy.      Sixth. 
* 


538  HYDROPS. DROPSY. 


1. ANASARCA. CELLULAR  DROPSY. 

Diagnosis. — The  term  anasarca  is  used  to  designate 
that  variety  of  dropsical  effusion  which  takes  place 
from  the  exhalents  of  the  sub-cutaneous  cellular  tis 
sue.  The  malady  first  manifests  itself  in  the  inferior 
extremities,  particularly  after  standing  or  walking  for 
some  time,  and  it  gradually  extends  upwards  until  the 
whole  sub-cutaneous  cellular  tissue  of  the  organism 
becomes  involved.  The  tumefaction  is  usually  soft, 
doughy,  and  inelastic,  pitting  on  pressure,  and  the 
skin  is  white,  shining,  and  below  the  medium  temper 
ature.  The  swelling  disappears,  in  a  great  measure, 
after  the  patient  has  been  for  some  time  in  the  recum 
bent  position,  but  returns  again  when  he  has  resumed 
the  erect  posture.  Cellular  dropsy  may  exist  for 
years  without  causing  serious  inconvenience,  when 
confined  to  the  inferior  extremities,  but  it  is  rare  that 
the  whole  cellular  surface  becomes  involved,  unless 
some  vital  disorganization  exists,  or  the  energies  of 
the  system  have  become  dangerously  impaired. 

The  cases  of  anasarca  attended  with  the  least  dan 
ger,  are  those  arising  from  scarlatina,  pregnancy,  loss  of 
blood,  debility  consequent  upon  convalescence  from 
acute  diseases,  abuse  of  arsenic  and  mercury,  enlarged 
inguinal  glands,  the  pressure  of  tumours,  or  any  other 
curable  cause  which  operates  to  prevent  the  free  re 
turn  of  the  venous  blood. 

Effusions  of  this  kind  may  very  properly  be  termed 
passive  dropsies,  for  we  agree  with  Dewees,  "  that 
there  are  both  active  and  passive  dropsies,  or  rather 
dropsies  that  depend  upon  an  increase  of  action  or  of 
inflammation,  and  others  where  there  may  be  a  mere 
loss  of  balance  between  the  exhalation  and  absorp 
tion." 

In  cases  of  dropsy  arising  from  venous  obstruc 
tion,  for  example,  the  venous  absorbents  below  the 
seat  of  the  obstruction,  are  preternaturally  distended 
with  blood,  and,  as  a  consequence,  their  powers  of 
absorption  proportionally  diminished,  while  the  arte 
rial  exhalents  exercise  their  function  with  the  usual 
activity.  In  this  manner  the  equilibrium  between  ex 
halation  and  absorption  is  destroyed,  and  dropsical 


HYDROPS. DROPSY.  539 

accumulations  obtain.  So  in  phthisis  pulmonalis,  and 
affections  of  the  heart,  the  blood  being  but  imperfect 
ly  decarbonized  in  its  passage  through  these  diseased 
organs,  becomes  congested  in  the  venous  absorbents, 
and  thus  gives  rise  to  diminished  absorption,  and  con 
sequent  serous  accumulations. 

Anasarca  is  not  usually  attended  with  much  con 
stitutional  disturbance,  or  with  symptoms  that  are 
painful.  There  are  present,  however,  coldness  of  the 
surface,  and  diminished  secretion  of  urine  and  sweat. 
The  countenance  is  also  pale  and  sallow,  and  the 
general  appearance  indicates  ill-health.  Not  unfre- 
quently  the  effusion  continues  to  increase  until  the 
affected  parts  become  enormously  distended,  and  fi 
nally  crack  and  give  issue  to  the  accumulated  serum. 
When  this  happens  in  erysipelatous  or  syphilitic  sub 
jects,  sloughing  and  gangrenous  ulcers  sometimes  su 
pervene,  which  prove  highly  troublesome  and  danger 
ous. 

Causes. — The  peculiar  condition  consequent  upon 
scarlatina,  measles,  phthisis  pulmonalis,  chlorosis,  and 
diseases  of  the  heart ;  venous  obstructions  caused  by 
the  gravid  uterus,  by  the  pressure  of  tumours,  enlarg 
ed  glands,  ligatures,  and  mechanical  injuries,  sudden 
and  excessive  loss  of  blood,  abuse  of  stimulants, 
arsenic  and  mercury. 


2. ASCITES,    OR    ABDOMINAL    DROPSY. 

Diagnosis. — Dropsy  of  the' belly  may  arise  suddenly 
in  consequence  of  acute  peritoneal  inflammation,  and 
be  attended  with  the  ordinary  symptoms  of  other 
febrile  diseases,  or  it  may  make  its  appearance  in  a 
gradual  and  imperceptible  manner,  unattended  by  any 
notable  constitutional  disturbance.  During  attacks  of 
peritonitis,  there  is  an  increased  exhalation  from  the 
inflamed  serous  vessels,  from  the  very  commencement 
of  the  disease,  and  so  long  as  the  whole  organism 
labours  under  the  exalted  action  incident  upon  the 
fever,  the  venous  absorbents  dispose  of  this  super 
abundance  of  serum ;  but  after  the  active  symptoms 
have  subsided,  a  corresponding  depression  obtains  in 
all  parts  of  the  economy,  except,  perhaps,  the  affected 


540  HVDROPS. — Diiorsv. 

membrane,  in  which  there  still  may  remain  a  sub- 
acute  inflammation  and  its  consequence,  a  preter 
natural  effusion  of  serum.  In  vigorous  constitutions, 
the  absorbents  continue  to  remove  the  exhalation  as 
fast  as  formed  ;  but  in  feeble,  delicate,  or  scrofulous 
subjects,  the  function  of  absorption  often  languishes, 
the  equilibrium  between  the  exhaling  and  absorbing- 
functions  is  destroyed,  and  an  ascites  is  the  result. 

The  signs  which  characterize  abdominal  dropsy  are, 
gradual  enlargement  of  the  abdomen,  first  observed  in 
the  epigastric  region,  and  afterwards  extending  over 
the  whole  abdomen  ;  tenderness  on  pressure  ;  diffi 
culty  of  breathing  on  taking  exercise,  and  some  time 
after  lying  down  ;  distinct  fluctuation  on  percussion  ; 
sallow  and  unhealthy  complexion  ;  dry  skin  ;  scanty 
secretion  of  high-coloured  and  sedimentitious  urine ; 
foul  tongue,  with  a  small  secretion  of  viscid  saliva  ; 
impaired  appetite  ;  constipation,  or  relax  ;  sensation 
of  weight  and  stiffness,  particularly  when  attempting 
to  move  about,  or  bend  the  body  ;  general  feeling  of 
languor  and  debility. 

The  only  diseases  which  are  liable  to  be  confounded 
with  ascites,  are  pregnancy  and  tympanitis  ;  but  the 
history  and  circumstances  of  each  case  will  enable  us 
to  distinguish  with  sufficient  facility  and  certainty  be 
tween  the  different  maladies.  In  ascites,  the  situation 
of  the  swelling,  the  fluctuation  on  percussion,  the 
suppression  of  urine,  dry  skin,  and  the  previous  his 
tory  of  the  case,  will  mark  the  nature  of  the  com 
plaint  ;  and  in  pregnancy,  the  gradual  swelling  at  the 
lower  part  of  the  abdomen,  the  suppression  of  the 
menses,  nausea  and  vomiting  ;  the  absence  of  fluctu 
ation  on  percussion,  and  the  motion  of  the  child,  will 
render  our  diagnosis  accurate.  Nor  will  the  acute 
physician  ever  mistake  tympanitic  distention  for 
ascites :  for  percussion,  auscultation,  and  an  absence 
of  the  characteristic  symptoms  of  dropsy,  will  enable 
him  to  decide  at  once  in  regard  to  the  real  nature  of 
the  case.  Indeed,  we  can  hardly  conceive  how  cer 
tain  eminent  surgeons  should  have  been  led  to  perform 
the  operation  of  what  they  have  afterwards  facetious 
ly  termed  "  dry  tapping"  when  the  distinguishing 


HYDROPS. DROPSY.  541 

marks  between  tympanitic  and  aqueous  distention  are 
so  easily  recognised. 

Authors  have  described  several  distinct  varieties  of 
abdominal  dropsy,  and  have  named  each  according  to 
its  precise  location ;  thus,  sub-cutaneous  ascites,  in 
which  the  effusion  takes  place  in  a  circumscribed 
cavity  or  sac  in  front  of  the  abdominal  muscles ;  va 
ginal  ascites,  arising  from  a  puncture  or  other  injury 
to  the  aponeurosis  of  the  muscles,  and  causing  effusion 
into  the  sheath  of  the  muscle  ;  peritoneal  ascites,  or 
effusion  within  the  serous  cavity,  and  in  some  rare  in 
stances,  on  the  outside  of  the  membrane  ;  Jiydatid  as 
cites,  in  which  the  water  is  enclosed  in  one  or  more 
thin  vesicles  ;  also  dropsy  of  the  epiploon,  of  the  me 
sentery,  of  the  intestines,  of  the  liver,  of  the  spleen,  of 
the  gall-bladder,  and  encysted  ascites.  This  minute 
classification  is,  however,  quite  unnecessary  for  prac 
tical  purposes,  since  ascites  is  often  complicated  not 
only  with  several  of  these  varieties,  but  with  hydro- 
thorax,  anasarca,  and  general  dropsy.  It  is  so  very 
rare  that  we  find  the  above-named  organs  affected 
separately,  that  we  question  the  propriety  of  recog 
nising  in  them  distinct  species  of  dropsy,  although  it 
is  of  some  importance  to  be  aware  of  the  fact  that 
these  distinct  effusions  may  occur. 

Causes. — The  most  common  causes  of  ascites  are  peri 
toneal  inflammation,  affections  ofthe  liver,  and  abuse  of 
stimulating  drinks.  It  may  also  proceed  from  venous 
obstruction,  general  debility  in  consequence  of  disease, 
loss  of  blood,  and  abuse  of  drugs. 

Prognosis. — Our  opinion  respecting  the  probable 
termination  of  ascites  will  be  determined  by  the  fol 
lowing  circumstances  :  old  age,  and  a  constitution  im 
paired  by  previous  disease  or  by  excesses,  must  al 
ways  render  our  prognosis  unfavourable.  Dropsies 
complicated  with  incurable  functional  derangement  of 
the  liver,  or  other  vital  organs,  and  venous  obstruc 
tions,  are  for  the  most  part  beyond  the  reach  of  medi 
cine.  On  the  other  hand,  ascites  consequent  upon 
acute  inflammation  of  the  peritoneum,  loss  of  blood, 
abuse  of  stimulants  and  drugs,  and  the  debility  arising 
from  fevers  and  other  acute  diseases,  may  generally 
be  set  down  ns  rumble.  When  the  maladv  occurs  in 


542  IIYDROPS. DROPSY. 

young  and  naturally  robust  constitutions,  our  prognosis 
will  be  still  more  favourable,  and  in  some  instances, 
may  afford  grounds  of  encouragement  in  highly  com 
plicated  cases. 

Paracentesis  abdominis,  or  tapping. — This  operation 
should  always  be  deferred  as  long  as  possible,  in  order 
to  allow  a  reasonable  time  for  the  action  of  medicines. 
If,  however,  the  accumulation  becomes  very  great, 
and  the  symptoms  are  so  urgent  as  to  prevent  all  ex 
ercise,  destroy  rest  in  a  sitting  or  recumbent  posture, 
and  thus  serve  to  wear  out  the  energies  of  the  system, 
the  operation  should  not  longer  be  delayed.  At  the 
same  time,  the  most  judicious  medicinal  treatment 
should  be  perseveringly  directed  to  both  the  proxi 
mate  and  remote  symptoms  of  the  malady.  The  ope 
ration  of  tapping  is  of  itself  simple,  and  entirely  unat 
tended  with  danger  when  proper  precautions  are  used  ; 
but  as  the  effusion  usually  takes  place  with  much 
more  rapidity,  after  the  serum  has  been  evacuated,  than 
before,  it  will  be  apparent  that  paracentesis  abdominis 
should  only  be  had  recourse  to  when  the  symptoms 
are  particularly  urgent. 

3. HYDROTHORAX,  OR  DROPSY  OF  THE  CHEST. 

Hydrothorax  is  either  idiopathic,  or  symptomatic  of 
some  other  organic  disease.  By  far  the  most  common 
source  of  the  affection,  and  one  which  constitutes  a 
serious  complication,  is  organic  disease  of  the  heart. 
Another  frequent  cause  of  dropsy  of  the  chest,  is  pro 
tracted  pleuritic  inflammation.  Dropsy  of  the  heart 
generally  co-exists  with  hydrothorax,  and  it  is  for  this 
reason  that  we  so  often  find  the  pulse  very  irregular. 
The  symptoms  are  most  urgent  during  the  night,  after 
the  patient  has  remained  some  time  in  the  recumbent 
posture.  The  breathing  becomes  rapid,  laborious,  and 
grunting,  with  frequent  sighing,  sudden  starting  during 
sleep,  anxious  and  distressed  expression  of  counte 
nance,  face  pallid  and  wax-like  ;  small  secretion  of 
high-coloured  urine  ;  puffiness  of  the  face  and  extremi 
ties  ;  fulness  of  the  chest ;  dull  sound  on  percussion. 
Dyspnoea  occurring  from  the  slightest  exercise,  or 
from  lying  down,  sudden  starting  up  with  fright,  du 
ring  sleep,  dull  sound  on  percussion,  and  irregular 


HYDROPS. DROPSY.  543 

pulsations  of  the  heart,  will  enable  us  to  recognise  the 
affection  without  difficulty. 

Laennec  assures  us  that  hydrothorax  accompanies 
many  acute  and  chronic  diseases,  and  that  "  its  pre 
sence  announces  the  approach  of  death,  which  it  often 
precedes  only  a  few  moments."  That  these  effusions 
do  sometimes  occur  but  a  short  period  before  death, 
from  organic  affections  of  the  heart,  and  possibly  of 
other  organs,  we  entertain  no  doubt,  for  several  cases 
have  come  under  our  observation,  strongly  corrobora 
tive  of  this  fact. 

As  dropsy  of  the  heart  is  so  constant  an  attendant 
on  hydrothorax,  and  the  symptoms  of  each  so  constant 
ly  similate  each  other,  it  is  unnecessary  to  enter  into 
a  separate  description  of  this  malady.  When  the  ef 
fusion  originates  from  an  affection  of  the  heart,  or  the 
pericardium,  there  will  always  be  a  predominance  of 
those  symptoms  which  characterize  cardaic  disease, 
and  afford  us  a  sure  guide  in  forming  our  diagnosis. 

Paracentesis  thoracis  may,  in  some  instances,  be  re 
sorted  to  with  unequivocal  advantage,  for  the  relief  of 
purulent  collections  within  the  thorax,  but  very  rarely 
in  hydrothorax.  We  have  in  two  instances  saved  life  by 
a  prompt  resort  to  this  operation,  where  matter  had 
accumulated  in  the  chest,  and  the  patients  were  at  the 
point  of  death  from  suffocation  ;  but  in  thoracic  drop 
sies,  very  slight  encouragement  can  be  offered  from 
its  performance,  although  in  extreme  cases  it  is,  not  to 
be  lost  sight  of,  since  recoveries  have  now  and  then 
taken  place  after  the  operation. 

4. OVARIAN    DROPSY. 

Iii  this  species  of  dropsy,  the  effusion  takes  place 
from  the  internal  face  of  the  membrane  which  encloses 
the  ovarium.  The  swelling  is  first  observed  in  the 
iliac  region,  in  the  form  of  a  small  elastic  tumour,  and 
unattended  with  pain,  uneasiness,  or  constitutional 
disturbance.  The  enlargement  generally  progresses 
very  slowly,  extending  upwards  towards  the  kidney 
of  the  affected  side,  then  crossing  the  abdomen  to  the 
opposite  side,  until  ultimately  it  comes  to  occupy  the 
whole  of  the  abdomen.  No  serious  inconvenience  is 
experienced,  until  the  tumour  has  attained  such  a  size 


544  HYDROPS. DROPSY. 

as  to  encroach  upon  the  bladder,  stomach,  diaphragm, 
intestines,  and  the  larger  blood-vessels,  thus  giving 
rise  to  difficulty  in  urinating,  sense  of  weight  and  un 
easiness  in  the  stomach,  dyspnoea,  colicky  pains  in  the 
bowels,  pains  in  the  side  and  chest,  diminution  of  the 
secretions,  and  oedema  of  the  feet  and  ankles. 

The  tumour  often  remains  stationary,  and  almost 
unnoticed  for  twenty  or  thirty  years,  when  some  sud 
den  exciting  cause  will  operate,  and  the  swelling  ra 
pidly  attain  an  enormous  size. 

The  contents  of  ovarian  tumours  vary  much  in  their 
character,  being  sometimes  serous,  sometimes  albumi 
nous,  or  purulent,  or  sebaceous,  or  fatty,  or  composed 
in  part  of  organized  structures.  Dr.  Clapp,  Surgeon 
to  Exeter  Hospital,  has  recently  reported  a  case  in 
which  the  contents  of  the  tumour  "  consisted  of  teeth, 
hair,  bony  deposit,  some  transparent  masses  of  a  cel 
lular  structure,  (as  examined  by  the  microscope,)  se 
rum,  sebaceous  matter,  and  granular  fat,  which  were 
contained  in  numerous  small  cysts.  Teeth  were  found 
in  all  parts  of  the  tumour,  and  were  counted  to  the 
number  of  forty-three  ;  some  were  contained  in  cysts, 
others  were  imbedded  in  the  semi-transparent  masses, 
and  two  or  three  were  growing  from  the  walls  of  the 
parent  cyst.  In  one  part,  a  few  were  imbedded  in  a 
mass  of  bone,  bearing  a  strong  resemblance  to  an 
upper  jaw  united  in  the  mesial  line." 

Fluctuation  can  rarely  be  perceived  in  the  swelling 
until  it  has  attained  a  considerable  size,  but  the  loca 
tion  of  the  tumour,  and  the  absence  of  pain  or  other 
unpleasant  symptoms,  will  enable  us  to  form  a  correct 
opinion  in  the  early  stage  of  the  complaint. 

5. HYDROCELE,    OR    DROPSY    OF    THE    TESTICLE. 

A  description  of  this  disease  is  appropriate  to  sur 
gery  rather  than  to  medicine,  but  as  the  usual  method 
of  cure  serves  to  corroborate  the  truth  ofsimiliasimili- 
bus,  we  make  some  allusion  to  the  subject  in  this  place. 

The  fluid  of  hydrocele  is  situated  within  the  tunica 
vaginalis  testis,  commencing  at  the  lower  part  of  the 
scrotum,  and  gradually  extending  upwards  until  it 
reaches  the  external  abdominal  ring.  The  tumour  is 
pyriform  in  shape,  firm  and  elastic  to  the  touch,  and 


HYDROPS. DROPSY.  545 

unattended  with  pain.  It  is  only  troublesome  from  its 
bulk  and  weight. 

Much  difficulty  is  sometimes  experienced  in  distin 
guishing  this  disease  from  enlargements  of  the  testi 
cle,  and  in  more  than  one  instance,  we  have  seen  this 
gland  destroyed  by  injudicious  attempts  to  draw  off 
wafer  from  chronic  enlargements  of  the  substance  of 
the  gland.  Generally,  dropsy  of  the  testicle  may 
be  recognised  by  its  peculiar  elasticity,  its  lightness, 
form,  its  origin  at  the  lower  part  of  the  scrotum, 
and  its  gradual  extension  upwards,  and,  lastly,  by  its 
transparency.  By  placing  the  swelling  in  front  of  a 
lighted  lamp  in  a  dark  room,  its  character  will  be 
apparent  from  its  transparency.  But  in  some  cases, 
from  the  great  thickness  of  the  tunica  vaginalis,  or  the 
dark  colour  and  density  of  the  enclosed  fluid,  no 
transparency  can  be  perceived.  In  these  instances, 
we  must  be  guided  by  the  fluctuation,  lightness,  form, 
painlessness,  and  general  history  of  the  case. 

Accumulations  of  fluid  also  occur  within  the  mem 
brane  of  the  spermatic  chord,  constituting  the  disease 
known  as  spcrmatocele.  This  is  a  local  affection, 
analogous  in  its  nature  to  hydrocele. 

Hydrocele  occasionally  occurs  as  a  congenital  dis 
ease,  arising  from  an  imperfect  closure  of  the  tunica 
vaginalis,  and  thus  permitting  the  fluids  of  the  abdo 
men  to  descend  into  its  cavity. 

Operation.— The  most  successful  means  of  treating 
hydrocele  is  to  evacuate  the  serum  by  means  of  the 
trochar  and  canula,  and  then  to  create  a  healthy  me 
dicinal  action  in  the  tunica  vaginalis,  with  suitable 
injections.  Merely  drawing  off  the  fluid  is  of  no 
avail  in  effecting  a  cure,  for  the  morbid  condition  of 
the  membrane  still  remains,  and  the  exhalents  again 
fill  up  the  cavity.  Change  then  the  morbid  condition 
of  the  structure,  and  supersede  it  by  a  new  and 
different  action,  and  you  will  cure  the  disease.  But 
it  will  be  said,  that  by  applying  our  remedies  directly 
to  the  structure,  we  are  obliged  to  create  more  in 
flammation  than  is  necessary  in  order  to  effect  a  cure. 
Show  us,  then,  how  it  can  be  effected  by  internal 
remedies,  with  any  kind  of  certainty, — point  us  to  a 


S46  HYDROPS. DROPSY. 

specific  which  will  reach  the  case,  and  we  will  be  of 
the  first  to  adopt  it. 

The  most  reliable  medicine  we  have  ever  used  as  an 
injection,  is  a  mixture  of  one  part  of  tincture  of  iodine 
to  two  parts  of  water.  Let  this  be  injected  within 
the  tunic,  and  remain  for  five  or  ten  minutes,  or  until 
sharp  pains  are  experienced  in  the  gland  and*  the 
spermatic  chord,  after  which,  carefully  permit  the 
fluid  to  escape  from  the  canula.  The  use  of  iodine  is 
not  apt  to  be  followed  by  sloughing,  or  undue  inflam 
mation,  yet  it  almost  invariably  suffices  to  effect  a 
permanent  cure. 

Other  injections  have  been  highly  extolled  by  sur 
geons,  as  solutions  of  alum,  zinc  and  lead,  port-wine, 
&c.,but  they  have  too  often  failed  in  my  hands  to  in 
spire  me  with  confidence  in  their  virtues,  while  uni 
form  success  has  given  me  every  reason  to  be  satisfied 
with  the  iodine, 

For  an  account  of  hydrocephalus,  we  refer  to 
page  381  of  this  work. 

Therapeutics. — It  has  been  already  observed,  that 
dropsy  is  usually  but  a  symptom  of  some  other  mala 
dy.  Some  of  the  causes  winch  induce  it,  operate  for 
a  certain  length  of  time,  and  then  subside  sponta 
neously,  together  with  its  symptoms  of  effusion. 
Amongst  this  class  of  causes  may  be  placed,  preg 
nancy,  temporary  pressure  of  tumours,  intermittent 
fevers,  and  inordinate  doses  of  arsenic. 

Another  class  of  causes  which  demands  the  gravest 
attention  of  the  physician,  consists  of  functional  de 
rangements  of  important  organs,  impaired  constitu 
tions,  protracted  debility  from  excessive  loss  of  animal 
fluids,  habitual  intemperance,  general  cachectic  habit 
of  body,  chlorosis. 

The  first  indication  of  cure  consists  in  removing, 
as  far  as  is  practicable,  the  cause  of  the  dropsy.  To  do 
this  successfully,  it  is  necessary  to  enter  into  a  minute 
investigation  respecting  the  private  habits  of  the  pa 
tient,  as  well  as  the  present  symptoms.  By  this  means, 
abuse  of  stimulants,  of  drugs,  and  excesses  of  all 
kinds,  may  be  guarded  against,  which  otherwise 
would  have  operated  unfavourably  during  our  cura 
tive  efforts. 


HYDROPS. DROPSY.  547 

As  a  general  rule,  pure  air,  moderate  exercise,  an 
agreeable  state  of  mind,  a  light  and  nutritious  diet, 
and  a  sufficient  quantity  of  warm  clothing,  should  be 
enjoined.  A  change  of  location,  or  a  sea- voyage,  are 
often  powerful  auxiliaries  in  the  treatment. 

When  dropsy  depends  upon  incurable  organic  af 
fections  of  the  heart  or  liver,  much  may  be  done  to 
wards  palliating  the  symptoms  and  protracting  the 
patient's  life,  by  an  avoidance  of  all  those  causes 
which  tend  to  aggravate  the  primary  source  of  the 
disease,  such  as  undue  physical  exertion,  violent  emo 
tions  and  passions,  &c. 

Our  efforts  should  also  be  directed,  without  cessa 
tion,  towards  changing  the  morbid  condition  of  the 
membrane  upon  which  the  dropsy  is  dependent.  Our 
remedies,  therefore,  must  cover  the  remote  as  well  as 
the  proximate  symptoms  of  the  malady. 

The  remedies  which  we  deem  most  valuable  in  the 
treatment  of  dropsical  effusions,  are,  apis  mel.,  arseni- 
cum  alb.,  digitalis,  china,  hellebore,  colchicum,  dulcama 
ra,  asparagus,  canlharides,  scillce,  hyd.  potasses,  mercu- 
rius,  uva  ursa,  elaterium. 

In  ascites  and  hydrothorax,  the  first  trituration  of 
the  common  honey-bee  has  proved  astonishingly  effica 
cious  in  our  hands.  The  influence  which  this  remedy 
exercises  upon  the  urinary  organs,  as  well  as  upon 
the  peritoneum  and  pleura,  is  of  the  most  prompt  and 
decided  character.  In  large  doses,  it  causes  a  sense 
of  fulness,  constriction,  or  of  suffocation  in  the  thorax ; 
difficult  and  anxious  respiration  ;  pain  and  tenderness 
of  the  abdomen,  increased  on  pressure  or  by  contact ; 
symptoms  worse  in  the  horizontal  posture  ;  great  se 
cretion  of  urine,  which  is  pale  or  of  a  straw  colour, 
and  deposites  a  reddish  or  brick-coloured  sediment ; 
frequent  desire  to  urinate,  and  strangury. 

Our  method  of  preparing  the  medicine  is  as  follows : 
Enclose  the  bees  in  a  close  vessel,  and  expose  them  to 
a  temperature  of  90°  (Fahr.),  until  all  moisture  has 
escaped  from  them,  and  they  are  sufficiently  dry  to 
pulverize  readily ;  we  then  triturate  five  grains  of 
this  powder  with  one  hundred  grains  of  sugar  of  milk 
for  the  usual  period,  and  administer  the  trituration  in 
grain  doses  from  two  to  four  times  in  twenty-four 


548  HYDROPS. — DROPSY. 

hours.  Whether  the  active  principle  of  this  substance 
consists  solely  of  the  virus  connected  with  the  sting 
of  the  insect,  or  whether  other  parts  possess  active 
properties,  we  know  not  :  our  opinion,  however,  in 
clines  to  the  former  view. 

We  quote  the  following  case,  which  occurred  in 
the  practice  of  Dr.  Taft,  of  Hartford.  The  patient,  a 
boy  of  twelve  years  of  age,  was  attacked  in  July, 
1849,  with  dysentery.  After  several  weeks  of  medi 
cation  under  an  allopathic  physician,  the  acute  symp 
toms  subsided,  and  the  evacuations  gradually  assumed 
their  natural  state,  but  there  remained  an  unnatural 
fulness  and  tenderness  of  the  abdomen,  some  difficulty 
of  respiration,  especially  on  assuming  the  recumbent 
position,  a  dry  and  harsh  skin,  and  a  materially  dimi 
nished  secretion  of  urine.  Notwithstanding  the  per 
severing  employment  of  the  usual  allopathic  routine 
of  cathartics,  mercurials,  and  diuretics,  the  patient 
continued  to  grow  worse,  his  abdomen  became  very 
much  distended  with  serum,  and  very  tender  to  the 
touch,  or  from  even  the  pressure  of  the  bed-clothes ; 
the  respiration  became  exceedingly  laborious  and 
difficult,  obliging  the  sufferer  to  remain  for  a  good 
portion  of  the  nights  in  his  chair  ;  impaired  appetite, 
an  almost  entire  suppression  of  urine,  emaciation, 
debility,  small  and  rapid  pulse,  anxious  expression, 
and  other  signs  accumulated. 

In  this  condition  he  came  under  the  care  of  Dr.  Taft, 
who  administered  digitalis,  arsenicum,  dulcamara,  mer- 
curius,  china,  sulphur,  hellebore,  as  the  symptoms  ap 
peared  to  indicate,  but  without  any  amelioration  of 
the  symptoms.  In  the  meantime,  the  increasing  diffi 
culty  of  respiration,  loss  of  rest,  of  appetite,  and 
pain,  had  reduced  the  patient  to  so  serious  a  condition, 
that  I  was  called  in  council  with  Dr.  Taft,  in  order  to 
decide  respecting  the  propriety  of  paracentecis  abdo- 
minis.  In  consideration  of  the  urgency  of  the  symp 
toms,  and  the  inefficiency  of  the  remedies  which  had 
been  used,  I  evacuated  the  effused  fluid,  amounting  to 
sixteen  pounds,  and  advised  a  second  trial  ot'arsenicum 
and  digitalis.  No  effects,  however,  resulted  from  their 
use  :  the  secretion  of  urine  remained  the  same,  the 
skin  dry  and  husky,  the  abdominal  effusion  continued, 


HYBROPS. DROPSY.  549 

the  oppression  of  the  chest,  sense  of  suffocation  and 
difficulty  of  breathing  gradually  increased,  and  signs 
of  thoracic  effusion  began  to  be  exhibited.  Recourse 
was  now  had  to  the  powder  above  alluded  to,  and 
with  the  most  speedy  and  marked  results.  After  two 
or  three  doses,  a  large  quantity  of  urine  was  passed, 
and  the  symptoms  were  all  ameliorated.  After  the 
remedy  had  been  continued  for  two  weeks,  all  traces 
of  effusion  disappeared,  the  appetite  and  strength  be 
gan  to  improve,  and  the  respiration  became  natural 
and  easy.  The  patient  continued  to  convalesce  without 
any  further  unfavourable  indication,  until  perfect 
health  was  restored.  We  have  witnessed  the  effects  of 
this  remedy  in  two  other  cases  of  ascites,  in  one  case 
of  protracted  general  dropsy,  and  in  one  case  of  hy- 
drothorax.  and  with  the  same  favourable  results.  The 
powder  of  dried  honey-bees  has  long  been  used  as  a 
remedy  in  dropsies  by  the  aborigines  of  our  country. 

Arsenicum. — External  indications. — General  appear 
ance  of  exhaustion  and  debility;  pallid,  waxen,  and 
sickly  countenance  ;  cheeks,  lips,  and  eyelids  bloated 
and  puffy,  causing  a  marked  alteration  in  the  expres 
sion  ;  dropsical  swellings  of  the  extremities  and  abdo 
men  ;  mouth  and  tongue  dry  ;  tongue  tremulous,  red, 
bluish,  or  covered  with  a  white  coat ;  urine  scanty, 
dark,  and  turbid  or  slimy  ;  general  coldness  and  dry- 
ness  of  the  skin ;  general  anasarca,  with  discharging 
vesicles  on  different  parts  of  the  affected  surface  ; 
emaciation  ;  dark  coloured  spots  or  blisters  on  differ 
ent  parts  of  the  body  ;  pulse  small,  feeble,  and  inter 
mittent. 

Physical  sensations. — General  sense  of  prostration  ; 
great  nervous  sensibility ;  paralytic  feeling  in  the 
swollen  parts  ;  palpitation  of  the  heart ;  turns  of  faint- 
ness  ;  great  difficulty  of  breathing  when  exercising, 
and  after  lying  down  ;  restlessness  ;  anguish  and  op 
pression  in  the  thorax  and  epigastric  region  ;  hum 
ming  and  roaring  in  the  ears  and  head  ;  bad  taste  in 
the  mouth ;  loss  of  appetite  ;  dry  ness  of  the  mouth 
and  tongue  ;  thirst ;  tenderness  of  the  abdomen  on 
pressure;  difficult  and  scanty  alvine  discharges,  or 
slight  diarrhoea ;  frequent  desire  to  urinate,  although 
but  a  small  quantity  is  secreted  ;  anxious,  difficult, 


550  HYDROPS. DROPSY. 

and  rapid  respiration  while  in  the  recumbent  posture  ; 
heaviness  and  stiffness  of  the  limbs  and  body  ;  dis 
turbed  sleep,  from  impeded  respiration,  dreams ; 
chilliness,  alternating  now  and  then  with  flushes  of 
heat ;  diminution  of  sensation  and  power  in  the 
swollen  parts  ;  symptoms  worse  after  eating,  exercise, 
and  lying  down. 

Mental  and  moral  symptoms. — General  mental  unea 
siness  ;  fits  of  anguish  and  discouragement ;  disincli 
nation  to  remain  long  in  one  position ;  apprehension 
that  it  is  impossible  to  recover. 

Digitalis. — External  indications. — This  remedy  has 
been  found  curative  in  general  anasarca,  ascites,  and 
hydrothorax  originating  in  organic  disease  of  the  heart ; 
also,  paleness  of  the  face ;  blue  lips ;  swelling  of  the 
eyelids  ;  coated  tongue  ;  scanty  secretion  of  high-col 
oured  urine ;  strong  and  visible  pulsations  of  the 
heart ;  irregularity  of  the  pulse  ;  general  paleness  of 
the  skin. 

Physical  sensations. — Vertigo  ;  pressure  in  the  fore 
head  and  vertex  ;  ringing  and  hissing  in  the  ears  ;  want 
of  appetite  ;  flat  taste  in  the  mouth  ;  thirst ;  pressure 
in  the  stomach ;  distention  of  the  abdomen,  with 
stitching  pains ;  pressure  at  the  neck  of  the  bladder, 
with  frequent  desire  to  urinate  ;  throbbing  in  the 
chest ;  sharp  stitches  in  the  region  of  the  heart ;  res 
piration  anxious  and  difficult  on  walking  or  lying 
down ;  lassitude  and  diminished  sensation  in  the  in 
ferior  extremities  ;  constant  inclination  to  sleep  ;  dis 
turbed  sleep  ;  faintness. 

Mental  and  moral  symptoms. — Dulness  of  intellect ; 
vertigo  ;  forgetfulness  ;  gloomy,  peevish  and  indiffer 
ent. 

Remarks. — Digitalis  has  proved  most  advantageous 
in  dropsy  consequent  on  organic  disease  of  the  heart, 
and  in  anasarca  following  scarlatina.  Dr.  Kurtz  con 
siders  digitalis  in  decoction  an  excellent  remedy  in 
this  complaint,  and  that  the  dilutions  are  useless. 

Scilla  has  been  employed  successfully  in  ascites 
and  anasarca,  by  Hartmann,  Currie,*Noack  and  Trinks. 
Hahnemann  did  not  entertain  a  high  opinion  of  this 
substance  as  a  remedy 'for  dropsy,  since  its  primary 
effect  was  to  stimulate  the  kidneys  and  cause  a  co- 


HYDROPS. DROPSY.  551 

pious  emission  of  urine,  while  its  secondary  effect  was 
always  the  opposite  of  this,  viz.,  to  suspend  almost 
entirely  the  urinary  secretion. 

China. — External  indications. — Countenance  pale  or 
sallow,  sunken  and  sickly ;  general  appearance  of 
languor  and  debility ;  dropsical  swellings  in  one  or 
more  parts  of  the  body  ;  enlargement  and  induration 
of  the  liver ;  emaciation  ;  dryness  of  the  skin,  mouth 
and  tongue  ;  urine  scanty,  pale  or  dark  coloured,  and 
depositing  a  brick-dust  sediment ;  coldness  of  the 
whole  surface  of  the  body;  skin  yellow ;  tremour  in 
the  limbs  when  attempting  to  walk. 

Physical  sensations. — Exhaustion  arising  from  pro 
tracted  acute  diseases,  from  excessive  loss  of  blood, 
and  from  abuse  of  drugs  ;  pain  and  tenderness  in  the 
region  of  the  liver  ;  heaviness  and  pressure  in  the 
head,  from  within  outwards  ;  humming  and  ringing  in 
the  ears  ;  bitter  or  flat  insipid  taste  ;  loss  of  appetite  ; 
thirst  for  cold  water  and  acids  ;  oppression  of  the  stom 
ach  and  abdomen,  especially  after  eating  or  drinking  ; 
constipation  ;  respiration  short,  rapid,  and  at  times 
suffocative  ;  nights  restless,  and  sleep  disturbed  by 
dreams  ;  great  sensitiveness  to  cold  ;  frequent  shud 
dering,  when  drinking  cold  water,  or  when  exposed  to 
the  air;  swelling  and  stiffness  of  the  limbs  ;  weariness 
of  the  limbs,  with  constant  desire  to  change  position ; 
symptoms  aggravated  by  contact,  by  eating,  and  at 
night. 

Mental  and  moral  symptoms. — Low  spirited,  nervous 
and  irritable  ;  sometimes  anxious,  gloomy  and  appre 
hensive  of  evil,  and  at  other  times  indifferent,  taciturn, 
and  stupid ;  confusion  of  ideas ;  disinclination  to 
physical  or  mental  labour. 

Remarks. —  China  will  be  found  curative  in  those 
dropsies  which  are  the  result  of  simple  debility  which 
has  been  caused  by  loss  of  animal  fluids,  protracted 
illness,  and  abuse  of  cathartics.  It  may  also  be  exhi 
bited  in  anasarca  consequent  on  attacks  of  intermit 
tent  and  other  fevers. 

Hellebore. — External  indications. — Face  and  lips 
swollen,  and  of  a  pale  or  yellowish  cast :  fluctuating 
swelling  of  the  abdomen  ;  general  anasarca  ;  spasmo 
dic  or  convulsive  movements  of  the  head  and  limbs  : 


KYDKOFS. DROPSY. 

twitching  of  the  eyelids ;  dulness  and  stupor ;  coldness 
of  the  surface  ;  suppression  of  urine. 

Physical  sensations. — Throbbing  or  compressive  pain 
in  the  head ;  oppression  at  the  chest  and  stomach  ; 
cramplike  pains  in  the  abdomen ;  frequent  desire  to 
urinate,  with  scanty  emission ;  loss  of  appetite  ;  nausea, 
and  pain  in  the  stomach  and  bowels,  followed  by  a 
loose  alvine  evacuation  ;  short,  dry  cough ;  difficul 
ty  of  breathing;  sharp  stitches  in  the  head,  chest  and 
abdomen ;  heaviness  and  rigidity  of  the  limbs  ;  symp 
toms  better  in  the  open  air. 

Mental  and  moral  symptoms. — Dulness  of  intellect ; 
weakness  of  memory ;  painful  stupefaction  of  the 
head ;  frequent  sighing  and  moaning ;  giddiness  on 
rising  up,  or  walking ;  confusion  of  ideas. 

Remarks. — Hellebore  is  particularly  commended  in 
dropsies  complicated  with  intermittent  fever,  after  the 
fever  has  been  cured  by  ars.9  also  in  anasarca  and 
ascites  of  children,  arising  from  scarlatina.  It  has 
effected  prompt  cures  of  dropsical  effusions  upon  the 
brain,  attended  with  convulsive  motions  of  the  head 
and  limbs. 

Colchicum. — External  indications. — Face  yellow  and 
cedematous ;  dropsical  swelling  of  the  abdomen ; 
oedema  of  the  feet  and  legs ;  visible  palpitation  of  the 
heart;  skin  dry  and  cold,  or  alternating  with  heat  dur 
ing  the  night;  rapid  and  difficult  respiration;  pulse 
full  and  hard,  or  quick  and  small ;  urine  scanty,  and 
dark  coloured. 

Physical  sensations. — Nausea,  burning  and  icy  cold 
ness  of  the  stomach  ;  distention  of  the  abdomen,  with 
pressure  and  colicky  pains  ;  abdomen  tender  on  pres 
sure  ;  loose  and  painful  stools ;  oppression  of  the  chest ; 
palpitation  of  the  heart ;  tearing  pains  and  stiffness  in 
the  back,  side,  and  limbs;  drowsy  during  the  day,  but 
restless  nights ;  symptoms  worse  during  the  night ; 
also  aggravated  by  mental  labour. 

Mental  and  moral  symptoms. — Tendency  to  exag 
gerate  symptoms ;  absence  of  mind  ;  forgetfulness  ; 
dissatisfaction  from  slight  causes. 

Remarks. — This  remedy  is  useful  in  dropsical  swell 
ings  caused  by  atmospheric  vicissitudes,  excessive 
mental  labour,  sudden  suppression  of  the  perspiration, 


HYDROPS. DROPSY.  553 

and  in   anasarca    consequent    upon    scarlatina    and 
measles. 

Dulcamara. — External  indications. — Face,  abdomen, 
and  limbs  bloated  ;  urine  small  in  quantity,  turbid,  and 
fetid  ;  heat  and  dryness  of  the  skin  ;  empty  eructations. 

Physical  sensations. — Loss  of  appetite  ;  dry  mouth 
and  tongue  ;  great  thirst  for  cold  drinks ;  empty  eruc 
tations  after  meals ;  nausea  ;  restless,  hot  and  fever 
ish  during  the  night ;  constipation  ;  catarrhal  symp 
toms  ;  symptoms  worse  at  night,  better  on  motion. 

Mental  and  moral  symptoms. — Irritable  and  angry 
disposition ;  also  scrofulous  and  phlegmatic  constitu 
tions,  and  great  sensitiveness  to  cold. 

Remarks. — Applicable  in  dropsies  which  have  arisen 
from  exposure  to  cold,  and  general  anasarca  conse 
quent  on  fever  and  ague,  scarlatina,  and  rheumatic 
fever. 

Asparagus. — External  indications.  —  Countenance 
pale,  waxlike,  and  bloated  ;  general  expression  of  anx 
iety  and  distress  ;  unusual  fulness  of  the  chest ;  cold 
ness  of  the  surface  ;  suppression  of  the  perspiration  ; 
urine  scanty,  straw-coloured,  and  offensive  to  the 
smell ;  visible  throbbing  of  the  heart,  especially  in 
the  night ;  rapid,  laborious,  and  sighing  respiration  ; 
pulse  feeble  and  irregular. 

Physical  sensations. — Feeble  appetite ;  sense  of 
fulness  and  oppression  after  eating  or  drinking ;  pal 
pitation  of  the  heart ;  great  oppression  of  the  chest, 
and  rapid  and  difficult  breathing,  increased  after  being 
in  bed  for  some  time  ;  sleep  uneasy  and  disturbed  by 
the  oppressed  respiration  ;  constant  inclination  to  be 
carried  about  in  the  arms  by  a  child  ;  great  languor 
and  disinclination  to  physical  or  mental  exertion ; 
stitching  pains  in  the  region  of  the  chest. 

Moral  symptoms. — Fretful  and  peevish  ;  disturbed 
by  trifles  ;  constant  anxiety  and  apprehension. 

Remarks. — In  two  cases  of  hydrothorax  following 
acute  attacks  of  peripneumonia,  in  children  of  three 
and  five  years  of  age,  I  have  found  asparagus  of  sig 
nal  service  after  several  other  remedies  had  failed. 
One  of  these  cases  was  complicated  with  an  organic 
affection  of  the  heart,  and  an  almost  entire  removal 
of  the  cardiac  symptoms  followed  the  cure  of  the 

24 


554  HYDROPS. DROPSY. 

dropsy.  We  are  quite  convinced  that  this  remedy 
will  prove  one  of  great  efficiency  in  the  treatment  of 
hydrothorax  and  general  dropsy,  and  we  respectfully 
urge  it  upon  the  attention  of  practitioners.  It  should 
always  be  advised  in  dropsies  as  an  article  of  food. 

Cantharides  is  recommended  in  dropsy  caused  by 
tonic  spasm  of  the  neck  of  the  bladder,  and  by  per 
verted  action  of  the  kidneys.  It  may  also  be  admi 
nistered  in  effusion  occurring  in  the  last  stages  of 
acute  and  chronic  diseases,  as  a  palliative. 

Hyd.  potasses  is  adapted  to  oadematous  swellings 
resulting  from  the  pressure  of  enlarged  glands  upon 
the  veins.  It  has  likewise  proved  highly  beneficial 
when  administered  by  me  for  the  relief  of  dropsy 
arising  from  Dr.  Bright's  granulated  kidney. 

Mercurius  has  been  praised  as  a  valuable  remedy 
in  chronic  hydrothorax,  and  in  ascites  from  diseased 
liver.  It  is  worthy  of  attention  in  ovarian  dropsy, 
and  effusions  dependent  upon  enlargement  of  the 
spleen. 

Uva  ursa  has  cured  several  cases  of  ascites  depend 
ent  upon  abuse  of  stimulating  drinks,  and  abuse  of 
drugs.  Its  influence  in  restoring  the  urinary  secre 
tions  is  usually  very  prompt  and  satisfactory. 

Other  remedies  which  have  occasionally  been  found 
useful  in  dropsies  are,  elaterium,  rhus  tox.,  lycopodium, 
bryonia,  ol.  tiglii,  potassce  nit.,  iodine,  solanum  nig. 
phosphorus,  baccce  juniper. 

Administration. — In  the  treatment  of  acute  dropsies, 
we  advise  the  employment  of  the  third  to  the  sixth 
attenuations,  and  a  repetition  of  the  dose  every  two 
or  four  hours  until  effects  from  the  medicine  are  ap 
parent.  In  chronic  dropsies,  we  employ  the  first  to  the 
third  attenuations,  and  repeat  once  or  twice  in  twenty- 
four  hours  until  a  suitable  impression  is  produced. 


555 
CHAPTER  XXIX. 

CHLOROSIS. 

General  description. — Young  unmarried  females,  of 
delicate  lymphatic  constitutions,  slight  figures,  and 
highly  impressible  nervous  systems,  are  by  far  most 
liable  to  attacks  of  chlorosis.  In  a  majority  of  in 
stances,  it  will  be  found  that  chlorotic  girls  have  been 
remarkable,  from  birth,  for  delicacy  of  organization, 
daintiness  of  appetite,  feebleness  of  digestion,  and 
undue  sensibility  of  the  whole  system.  So  long  as 
this  nervous  sensibility  is  not  overtasked,  and  no  im 
portant  causes  operate  to  derange  the  delicate  equili 
brium  upon  which  the  proper  operation  of  the  func 
tions  depends,  the  individual  enjoys  passably  good 
health  ;  but  when  the  period  of  puberty  arrives,  and 
nature  calls  for  her  monthly  tribute  from  the  vital 
fluid  itself, — when  new  thoughts  and  new  desires 
powerfully  stimulate  the  system, — when,  in  fine,  the 
important  change  of  the  whole  organism,  during  the 
establishment  of  the  catamenial  function,  occurs,  then 
the  frail  balance  is  destroyed,  the  digestive,  absorbent, 
and  assimilative  functions  fail,  and  those  symptoms 
which  mark  chlorosis  make  their  appearance. 

The  disease  sometimes  attacks  married  females 
even  when  considerably  advanced  in  years  ;  and  it 
has  likewise  been  observed  in  girls  of  two  or  three 
years  of  age  ;  but  cases  of  these  kinds  are  of  extreme 
ly  rare  occurrence.  Men  of  studious  and  sedentary 
habits,  especially  those  who  have  never  taken  much 
exercise,  have  been  occasionally  subjected  to  it. 

Chlorosis  is  more  common  in  cold  than  in  warm 
climates.  This  circumstance  is  attributable,  in  part, 
to  the  pernicious  custom  at  the  north,  of  keeping  chil 
dren  a  large  portion  of  the  year  in  close  rooms,  at  a 
temperature  of  75  to  80°  Fahrenheit,  thus  preventing 
that  free  development  of  the  body  which  would  result 
from  pure  air  and  abundant  exercise.  Another  reason 
offers  itself  in  the  fact,  that  persons  of  frail,  nervous, 
and  lymphatic  constitutions,  cannot  often  withstand 


556  CHLOROSIS. 

the  severities  of  a  temperate  latitude,  without  suffer 
ing  more  or  less  from  disorders  of  the  glandular  and 
membranous  structures. 

Diagnosis. — The  symptoms  commonly  observed  du 
ring  the  forming  stage  of  chlorosis  are,  derangement 
of  the  stomach  and  bowels,  manifested  by  a  pale  and 
bloated  appearance  of  the  tongue,  foul  breath,  partial 
or  total  loss  of  appetite,  morbid  craving  for  certain 
indigestible  articles,  like  coal,  chalk,  clay,  acids,  pen 
cils,  etc. ;  torpid  state  of  the  bowels  ;  tympanitic  dis- 
tention  of  the  abdomen,  accompanied  with  occasional 
griping  pains ;  faecal  discharges,  composed  of  crude 
and  imperfectly  digested  substances,  unnatural  in 
colour  and  consistence. 

Soon  after  the  appearance  of  these  symptoms,  if 
;he  disease  continues,  the  patient  becomes  listless,  ir 
ritable,  fond  of  solitude,  and  disinclined  to  bodily  or 
mental  exertion  ;  the  menstrual  function  becomes  de 
ranged  ;  the  face  pale  and  tumid  ;  the  lips  lose  their 
colour ;  the  eyelids  are  swollen  and  surrounded  by  a 
dark,  greenish,  or  yellowish  circle ;  emaciation  com 
mences  ;  the  debility  and  lassitude  become  more  ap 
parent  ;  many  nervous  and  hysteric  symptoms  mani 
fest  themselves ;  dyspnoea,  and  palpitation  of  the 
heart,  or  "  fluttering  about  the  pra3cordia,"  (Hall,) 
occur  from  ascending  stairs,  from  rapid  walking,  or 
violent  mental  emotions  ;  the  patient  is  troubled  with 
vertigo,  giddiness,  and  ringing  in  the  ears  and  head  ; 
sleep  is  disturbed  by  unpleasant  dreams  ;  the  spirits 
become  depressed,  and  the  ambition  and  energy  are 
superseded  by  apathy  and  indifference. 

As  the  disease  advances,  all  these  symptoms  become 
more  strongly  pronounced,  and  confirmed  chlorosis  is 
developed.  The  whole  surface  of  the  body  now  as 
sumes  a  smooth  and  puffy  appearance ;  the  skin  is 
dry,  pale  or  yellowish,  or  lead-coloured  ;  the  muscles 
soft  and  flabby ;  the  feet  and  ankles  cedematous  ;  the 
countenance  very  pallid  and  waxlike  ;  the  prolabia  of 
a  lilac  colour ;  tongue  clean,  bloodless,  and  semi- 
transparent  ;  conjunctiva  of  a  clear  white  colour,  or 
slightly  tinged  with  blue  ;  pulse  feeble  and  somewhat 
rapid;  occasional  pains  in  the  head,  chest,  stomach, 
side  and  abdomen ;  throbbing  of  the  carotid  arteries, 


CHLOROSIS.  557 

perceptible  to  the  sight  and  hearing  ;  violent  palpita 
tion  of  the  heart ;  dyspnoea,  and  "  fluttering  about  the 
praecordia,"  after  the  slightest  physical  or  mental  ex 
ertion,  and  often  during  the  night ;  catamenial  secre 
tion,  superseded  by  a  profuse  leucorrhoeal  discharge; 
slight  hacking  cough  on  rising  in  the  morning,  and 
after  exercise  ;  frequent  loose  discharges  from  the 
bowels  of  a  dark  or  black  colour,  and  very  fetid  ; 
extreme  prostration  of  all  the  energies ;  marked  de 
rangement  of  the  functions  of  the  liver,  kidneys,  skin, 
and,  indeed,  of  nearly  every  part  of  the  body. 

It  is  not  an  uncommon  occurrence  for  some  of  these 
symptoms  to  assume  a  serious  local  aspect  during  the 
progress  of  the  complaint,  and  thus  present  highly 
troublesome  and  dangerous  complications.  Marshall 
Hall  enumerates  these  complications  as  follows  : 

First,  pain  in  the  head ;  second,  cough  and  dysp 
noea  ;  third,  palpitation  of  the  heart ;  fourth,  pain 
and  tenderness  of  the  side  ;  fifth,  pain  and  tender 
ness  of  the  abdomen  ;  sixth,  constipation  ;  seventh, 
diarrhoea  ;  eighth,  meloena  ;  ninth,  menqrrhagia  ; 
tenth,  tendency  to  hsemorrhagy ;  eleventh,  purpura ; 
twelfth,  leucorrhoea  ;  thirteenth,  hysteric  affec 
tions  ;  fourteenth,  oedema,  anasarca,  erythema  no- 
dosum. 

It  should  be  borne  in  mind,  that  all  of  these  compli 
cations  are  nothing  more  than  symptoms  of  the  origi 
nal  malady,  and  are  to  be  treated  only  as  such.  We 
have  deemed  it  important  to  direct  special  attention 
to  these  symptoms,  to  guard  the  inexperienced  physi 
cian  against  mistaking  them  for  distinct  and  inde 
pendent  affections.  When  either  of  them  is  particu 
larly  prominent,  the  careless  diagnostician  is  apt  to 
form  an  incorrect  opinion  of  the  case.  Thus,  frequent 
pains  in  the  chest,  violent  palpitation  of  the  heart  on 
the  slightest  exertion,  and  an  irregular  or  intermittent 
pulse,  have  often  caused  medical  men  to  mistake  an 
ordinary  chlorosis  for  an  organic  affection  of  the  heart : 
so  have  the  cough  and  dyspnoea,  and  the  gastric  and 
abdominal  derangements,  which  accompany  chlorosis, 
been  mistaken  for  phthisis  pulmonalis  and  dyspepsia. 

We  have  included  amongst  the  signs  of  chlorosis, 
suppression  of  the  menses,  but  this  is  by  no  means  an 


558  CHLOROSIS. 

invariable  symptom,  as  numerous  cases  are  reported 
in  which  the  catamenial  secretion  was  perfectly  natu 
ral  and  regular  during  the  whole  course  of  the  com 
plaint.  We  may  safely  infer,  therefore,  that  it  is  not 
dependent  on  retention  of  the  menses,  as  some  writers 
have  supposed. 

We  have  already  seen  that  many  of  the  symptoms 
of  chlorosis  strongly  resemble  those  of  organic  affec 
tions  of  the  heart,  pulmonary  phthisis,  dyspepsia,  liver 
complaint,  and  dropsy,  but  a  minute  examination  of 
the  history  and  symptoms  of  each  case,  will  always 
enable  us  to  form  a  correct  diagnosis.  Thus,  disease 
of  the  heart  is  attended  with  more  pain,  and  more 
febrile  disturbance,  than  chlorosis  :  the  expression  of 
the  eyes,  and  the  appearance  of  the  prolabia  and 
tongue  are  also  widely  different.  The  pure  white 
colour  of  the  conjunctiva,  and  the.  bilious  and  dark 
colour  of  the  faeces,  will  sufficiently  mark  the  disease 
from  chronic  hepatitis.  From  consumption  of  the  lungs, 
we  may  also  recognise  it,  by  the  absence  of  febrile 
exacerbations,  the  flushed  cheek,  the  copious  purulent 
expectoration,  and  the  more  general  emaciation  which 
occurs  in  the  former.  There  are  also  numerous  symp 
toms  by  which  we  may  readily  distinguish  it  from 
dyspepsia  and  dropsy. 

Causes. — There  are  several  points  connected  with 
chlorosis  worthy  of  much  consideration  in  a  patholo 
gical  and  therapeutical  point  of  view,  viz. :  first,  the 
prominent  gastric  and  intestinal  derangement  at  the 
commencement  of  the  malady ;  second,  the  small 
quantity  of  crassimentum  in  the  blood ;  and  third,  the 
peculiar  state  of  the  capillary  system,  which  gives 
rise  to  a  haemorrhagic  tendency. 

From  the  history  of  chlorosis,  it  appears  that  the 
stomach  and  bowels  are  the  first  structures  to  take  on 
disordered  action.  For  some  time  previous  to  the  ap 
pearance  of  the  pale,  waxlike  and  tumid  countenance, 
the  puffiness  of  the  eyelids,  the  loss  of  flesh,  suppres 
sion  of  the  menses,  and  other  signs  of  confirmed  chlo 
rosis,  we  observe  an  impaired  and  delicate  appetite, 
flabby  and  coated  tongue,  foul  breath,  imperfect  di 
gestion  of  the  food,  unnatural  stools,  and  all  those 
traits  which  characterize  a  feeble  and  imperfect  per- 


CHLOROSIS.  559 

formance  of  the  digestive,  absorbent,  and  assimilative 
functions.  The  symptoms  which  succeed  are  such  as 
naturally  result  from  such  gastric  and  intestinal  de 
rangement. 

These  facts  go  far  towards  explaining  the  small 
amount  of  crassimentum  contained  in  the  blood  of 
chlorotic  patients.  If  digestion,  absorption,  and  as 
similation  were  normally  executed,  would  not  the 
blood  receive  its  due  proportion  of  crassimentum,  and 
the  muscles  and  integuments  their  appropriate  supply 
of  the  red  globules  ?  The  organs  of  the  body  are 
dependent  for  healthy  action  upon  the  stimuli  of  these 
red  globules,  which  abound  in  oxygen,  and  serve  to 
communicate  to  all  parts  of  the  organism  its  animal 
heat  and  consequent  vitality.  Whenever,  therefore, 
any  cause  operates  upon  the  digestive  and  absorbent 
organs  in  such  a  manner  as  to  suspend  their  functions, 
the  blood  must  fail  of  its  due  supply  of  red  globules, 
and  a  derangement  of  all  the  organs  ensue. 

In  some  chlorotic  patients,  there  is  a  peculiar  ten 
dency  to  haemorrhages  from  the  nose,  the  lungs,  the 
stomach,  and  the  uterus.  Bloody  discharges  have 
been  known  'from  the  head,  the  side,  palms  of  the 
hands,  and  limbs,  in  instances  assuming  a  periodical 
form,  and  taking  the  place  of  the  menstrual  discharge. 
On  this  account,  the  disease  has  been  attributed  by 
some  to  a  laxity  of  the  capillaries,  and  a  consequent 
inability  to  exclude  the  red  globules ;  but  this  relaxed 
condition  of  these  vessels  is  owing  to  an  absence  of 
their  healthy  natural  stimuli,  the  "  oxygen  carriers," 
rather  than  to  any  primary  derangement  in  the  capil 
lary  vessels  themselves. 

Other  causes  which  may  contribute  to  the  develop 
ment  of  chlorosis,  in  constitutions  predisposed  to  it, 
are,  close  confinement  in  overheated  and  ill-ventilated 
apartments  ;  studious  and  sedentary  habits  ;  protract 
ed  grief,  anxiety,  or  fatigue  ;  parturition,  and  its  after 
effects;  leucorrhoea  ;  amenorrhoea ;  unsatisfied  love; 
masturbation ;  prolonged  continence  ;  frequent  haem 
orrhages  ;  crude  and  indigestible  food  ;  chronic  in 
flammation  of  the  intestinal  canal ;  enlargement  and 
inaction  of  the  mesenteric  glands. 

Prognosis. — This  will  depend  principally  upon  the 


560  CHLOROSIS. 

natural  stamina  of  the  patient,  and  the  severity  of 
the  local  symptoms.  A  frail  and  delicate  constitution, 
a  highly  susceptible  nervous  system,  a  decided  predis 
position  to  glandular  and  membranous  disease,  and 
an  inherent  debility  of  the  digestive  apparatus,  are 
circumstances  calculated  to  render  the  prognosis  un 
favourable.  Patients  of  this  description  are  rarely 
able  to  withstand  the  important  changes  which  the 
economy  undergoes  at  the  period  of  puberty,  without 
serious  local  disease,  and  often  organic  degenerations 
of  some  vital  part. 

On  the  other  hand,  if  the  patient  be  of  a  naturally 
robust  and  sound  constitution,  even  if  the  chlorotic 
symptoms  are  quite  severe,  we  may  generally  predict 
an  ultimate  recovery.  Here  we  may  trace  all  the 
causes  of  the  malady,  and  bend  our  efforts  to  their 
removal  with  a  prospect  of  success,  and  thus  restore 
the  system  to  its  original  health  and  vigour ;  while  a 
body  which  "  has  been  sent  into  this  breathing  world 
before  its  time,  but  half  made  up,"  cannot  be  re 
modelled  into  one  of  "  fair  proportions  "  and  vigour,  by 
any  resources  of  the  physician,  although  much  may 
be  done  towards  prolonging  life,  and  securing  a  mode 
rately  comfortable  state  of  existence. 

Pathology. — In  the  autopsical  examinations  of  those 
who  have  died  of  chlorosis,  the  most  notable  signs  of 
disease  are  found  in  the  blood,  the  muscles,  and  the 
surface  of  the  body.  The  blood  of  chlorotics  appears 
to  be  deprived,  in  a  great  measure,  of  the  red  mate 
rial,  and  its  place  supplied  by  a  superabundance  of 
serum.  This  condition  exists  to  a  greater  or  less  de 
gree  during  the  whole  course  of  the  disease,  and  it 
is  on  this  account  that  the  muscles  after  death  pre 
sent  a  peculiarly  pale  and  bloodless  appearance,  and 
the  skin  a  palish  yellow  or  waxlike  tinge.  Unnatural 
appearances  are  sometimes  found  in  the  chest  and 
alimentary  canal,  in  the  form  of  enlargement  and  di 
lation  of  the  ventricles  of  the  heart,  chronic  inflam 
mation  of  the  lungs,  the  stomach,  and  the  intestines, 
flabby  and  shrunken  appearance  of  the  liver  and 
spleen,  and  unusual  accumulations  of  serous  fluid  in 
the  cavities,  and  in  the  cellular  tissue. 

Therapeutics. — In  the   treatment   of  chlorosis,  we 


CHLOROSIS.  56  J 

find  of  especial  importance,  frequent  exercise  in  the 
open  air,  either  by  gestation  or  moderate  walking,  a 
highly  digestible  and  nutritious  regimen,  and  fresh  or 
salt  water  baths.  It  is  very  desirable  that  chlorotic 
patients  pass  their  winters  in  warm  and  equable  cli 
mates,  that  exercise  in  the  open  air  may  be  taken 
with  advantage  at  all  seasons.  This  is  necessary  on 
account  of  their  extreme  sensitiveness  to  the  cold, 
which  is  often  a  serious  obstacle  against  exposure  to 
the  low  temperature  of  northern  winters.  The  influ 
ence  of  sea  air  is  often  very  beneficial  to  patients  ac 
customed  to  inland  districts,  and  vice  versa.  Short 
sea-voyages  may  sometimes  be  advised  in  the  warm 
summer  months,  but  caution  should  be  exercised  that 
the  changes  be  not  too  abrupt. 

General  bathing  is  also  useful  when  properly  em 
ployed.  We  should  commence  with  tepid  baths  of 
fresh  or  salt  water,  and  gradually  diminish  the  tem 
perature  as  the  strength  will  admit,  until  an  ordinary 
cold  bath  can  be  advantageously  sustained.  Sensi 
tiveness  to  applications  of  cold  water,  will  frequently 
deter  the  patient  from  a  persevering  use  of  this  pow 
erful  remedy,  and  rigid  directions  should  therefore  be 
given  upon  the  subject. 

A  regimen  of  the  most  digestible  and  nutritious 
meats,  as  mutton,  venison,  beef,  game,  and  fowls,  with 
rich  animal  soups,  should  be  enjoined.  Other  nutri 
tious  food  which  the  stomach  will  digest  may  like 
wise  be  eaten.  Wine,  porter,  and  Scotch  ale  may  be 
used  at  meals  if  agreeable  to  the  invalid.  In  a  word, 
all  of  those  articles  which  are  calculated  to  enrich 
the  blood  with  the  red  globules,  may  be  resorted  to. 

The  remedies  best  adapted  to  meet  chlorotic  symp 
toms  are,  china,  sulphur,  nux  vomica,  pulsatilla,  sepia, 
ferrum  carb.,  platina,  calcarea  carb.,  conium,  arsenicum, 
veratrum. 

China. — External  indications. — Countenance  pale  or 
livid  ;  lips  blackish  and  shrivelled ;  mouth  and  tongue 
slimy  ;  skin  yellowish  ;  oedematous  swellings  of  the 
limbs  ;  faeces  hard  or  soft,  foetid,  mixed  with  undigest 
ed  food,  and  of  a  dark  or  black  colour  ;  offensive 
breath  ;  copious  leucorrhoeal  discharge  ;  menstrual 
fluid  scanty,  and  possessing  but  little  colour  ;  sup- 

24* 


562  CHLOROSIS. 

pression  of  the  menses  ;  haemorrhages  from  the  nose, 
mouth  and  lungs  ;  pulse  feeble  and  more  rapid  than 
natural  ;  general  appearance  indicative  of  an  exsan- 
guious  and  debilitated  condition. 

Physical  sensations. — Vertigo,  worse  when  walking 
or  during  motion  ;  humming  in  the  ears ;  disagreea 
ble  taste  in  the  mouth,  generally  bitter  or  insipid  ; 
unnatural  appetite ;  canine  hunger  ;  pressure  in  the 
stomach  after  eating  ;  distention  of  the  abdomen  from 
wind  or  water  ;  morbid  sexual  desire,  with  nightly 
pollutions  ;  difficult  and  rapid  respiration  ;  throbbing 
in  the  sternum  ;  palpitation  of  the  heart ;  constant  in 
clination  to  move  the  limbs ;  excessive  sensitiveness 
of  the  whole  nervous  system,  with  general  feeling  of 
lassitude  and  debility  ;  great  dread  of  cold  air  ;  drow 
siness  during  the  day,  but  restlessness  at  night  ;  sleep 
disturbed  by  frightful  dreams. 

Mental  and  moral  symptoms. — Nervous,  irritable, 
dissatisfied,  taciturn,  out  of  humour  ;  indisposition  to 
mental  exertion  ;  suspicious  of  dislike  and  abuse. 

Remarks. — China  is  eminently  a  specific  in  chlorosis 
accompanied  or  induced  by  profuse  loss  of  animal 
fluids,  from  epistaxis,  haemoptysis,  haemorrhoids,  mas 
turbation,  involuntary  emissions  of  semen,  leucorrhoea, 
and  diarrhoea.  It  is  one  of  our  best  remedies  when 
the  disease  is  uncomplicated  by  any  serious  local  de 
rangement,  and  where  simple  debility  of  the  whole 
organism  is  its  essential  characteristic. 

Sulphur.  —  External  indications. — Face  pale  and 
bloated  ;  eyes  surrounded  by  blue  or  greenish  margins  ; 
swelling  of  the  upper  eyelid ;  glandular  swellings 
about  the  neck  and  lower  jaw  ;  mouth  and  tongue 
slimy  ;  foetid  breath  ;  distention  of  the  stomach  and 
abdomen  ;  discharges  from  the  bowels  brown,  and 
mixed  with  undigested  food  ;  acrid  leucorrhoeal  dis 
charge  ;  profuse  expectoration  ;  short  and  rapid  respi 
ration  ;  oedema  of  the  feet  and  ancles  ;  surface  of  the 
body  covered  with  yellowish  or  brown  spots. 

Physical  sensations. — Vertigo,  dizziness  and  dulness 
in  the  head  ;  humming  or  roaring  in  the  ears  ;  putrid 
or  bitter  taste  in  the  morning  ;  loss  of  appetite  ;  crav 
ing  for  sweet  or  sour  articles  only  ;  pressure  of  the 
stomach  and  abdomen,  and  dyspno3a  after  eating  ; 


CHLOROSIF.  563 

throbbing  at  the  pit  of  the  stomach,  with  faintness  ; 
morbid  sexual  desire,  with  feeble  power  of  accom 
plishment  ;  frequent  involuntary  emissions  ;  menses 
too  early  and  too  profuse ;  burning  leucorrhoeal  dis 
charge  ;  weakness  of  the  chest  when  talking  ;  short 
and  difficult  breathing  on  exercise,  and  on  retiring  to 
bed  in  the  night  ;  frequent  palpitation  of  the  heart  ; 
stitches  and  pains  in  the  chest  when  moving  the  arms; 
coldness  of  the  feet ;  drowsiness  in  the  day  time,  but 
wakefulness  and  restlessness  during  the  night  ;  vivid 
dreams  ;  night  sweats  ;  constant  inclination  to  change 
position  ;  general  nervous  irritation  ;  sensitiveness  to 
cold  ;  internal  coldness  ;  lassitude  and  sensations  of 
faintness, — all  of  which  symptoms  are  without  acute 
pain,  and  are  mitigated  by  rest,  and  worse  during 
motion. 

Mental  and  moral  symptoms. — Sadness,  despondency, 
and  inclination  to  weep  without  cause  ;  ill  humour, 
obstinacy,  sadness,  silence,  and  frequent  moaning. 

Remarks. — This  medicine  is  advised  for  chlorotics  of 
a  lymphatic  temperament,  and  those  subject  to  fre 
quent  haemorrhages.  Also  in  chlorosis  complicated 
with  tuberculous  ulceration  of  the  lungs. 

Nux  vomica. — External  indications. — Pale,  yellow 
ish,  or  clay-coloured  complexion ;  sclerotica  natural ; 
cheeks  and  eyelids  swollen  ;  tongue  white  ;  foetid 
breath  ;  faeces  foetid  and  dark-coloured  ;  discharges  of 
blood  from  the  rectum  ;  moaning  and  incoherent  mut 
tering  during  sleep. 

Physical  sensations. — Vertigo,  giddiness,  or  sense  of 
intoxication  ;  tenderness  of  the  scalp  ;  ringing  and 
hissing  in  the  ears  ;  putrid,  or  bitter,  or  sour  taste  in 
the  mouth  ;  aversion  to  food  of  all  kinds,  and  to  tea 
and  coffee  ;  distention  and  oppression  of  the  stomach 
after  eating  ;  nausea  ;  bitter  or  sour  eructations  ; 
throbbing  sensation  in  the  region  of  the  stomach  ;  flatu 
lent  distention  of  the  abdomen,  and  colicky  pains  after 
eating  or  drinking ;  bleeding  and  painful  haemorrhoids  ; 
great  irritability  of  the  sexual  organs,  especially  after 
waking  in  the  morning  ;  menses  too  early,  and  scanty ; 
frequent  turns  of  nausea  and  faintness  during  the  men 
strual  flux  ;  asthmatic  respiration  when  walking,  and 
at  night  in  bed  ;  palpitation  of  the  heart  after  a  gen- 
is  meal  ;  painful  shocks  in  the  praecordial  region  : 


564  CHLOROSIS. 

sensitiveness  of  the  whole  surface  of  the  body ;  trem 
bling  in  the  limbs  when  walking  ;  sleep  disturbed  by 
dreams,  and  so  unrefreshing  that  the  patient  feels 
worse  in  the  morning  than  in  the  evening  ;  coldness 
of  the  feet. 

Mental  and  moral  symptoms. — Great  sensibility  to 
impressions  ;  noise,  bright  lights,  and  strong  odours 
intolerable  ;  sad ;  anxious  ;  quarrelsome  ;  taciturn  : 
apprehensive  of  death. 

Remarks. — When  chlorosis  is  preceded  and  accom 
panied  by  marked  derangement  of  the  alimentary 
canal,  more  particularly  if  the  patient  is  of  studious 
and  sedentary  habits,  and  has  indulged  freely  in  wines, 
coffee,  or  tobacco,  nux  vomica  is  indicated.  Those 
who  are  naturally  somewhat  robust,  and  of  a  quar 
relsome,  ardent  and  vehement  temperament,  will  be 
more  benefited  by  it  than  persons  of  a  mild  and 
phlegmatic  temperament. 

Pulsatilla. — External  indications. — Face  pale  ;  eye 
lids  puffy  ;  tongue  white  and  covered  with  viscid  mu 
cus  ;  pulsation  at  the  pit  of  the  stomach,  perceptible  to 
the  pressure  of  the  hand  ;  stools  loose,  green,  slimy,  or 
bloody ;  acrid,  thin  leucorrhoea  ;  scanty  menstrual  dis 
charge  ;  rapid  breathing  after  eating  or  on  lying 
down  ;  coldness  of  the  hands  and  feet. 

Physical  sensations. — Vertigo,  resembling  intoxica 
tion  ;  bad  taste  in  the  mouth  in  the  morning  ;  loss  of 
appetite ;  absence  of  thirst ;  nausea  ;  frequent  eruc 
tations  of  wind,  tasting  of  the  ingesta ;  beating  and 
fluttering  in  the  stomach  ;  cutting  pains  in  the  side 
and  abdomen ;  suppression  of  the  menses,  with  gene 
ral  coldness  of  the  body  and  nausea ;  asthmatic  op 
pression  of  the  chest  after  eating,  or  when  lying  on  the 
side  in  the  recumbent  posture ;  pain  and  weakness  in 
the  small  of  the  back  ;  disagreeable  pulsation  of  the 
arteries  of  the  whole  body ;  tremulousness  ;  weari 
ness  ;  restlessness  during  the  night ;  palpitation  of  the 
heart,  after  eating  or  talking. 

Mental  and  moral  symptoms. — Anxiety;  disgust  of 
everything  ;  sullenness  ;  whimsicalness ;  dissatisfac 
tion. 

Remarks.— Pulsatilla  is  adapted  to  chlorotics  who 
have  been  irregular  in  menstruation,  and  are  of  a 


CHLOROSIS.'  565 

mild,  timid,  yielding,  or  sad  disposition.  When  there 
is  a  total  suppression  of  the  menses,  with  much  pain 
in  the  small  of  the  back,  frequent  turns  of  chilliness, 
and  absence  of  thirst,  it  will  be  indispensable,  either 
by  itself,  or  in  alternation  with  some  other  medicine. 

Sepia. — External  indications. — Swollen  and  puffy 
appearance  of  the  whole  body ;  face  puffy,  pale  or 
yellow  ;  eyes  surrounded  by  blue  or  greenish  margins  ; 
tongue  coated  with  a  white  fur  ;  fostid  breath ;  men 
ses  too  early  and  scanty ;  yellowish,  watery,  or  mu 
cus  leucorrhoBa  ;  cold  feet  and  hands  when  in  bed  in 
the  evening. 

Physical  sensations. — Painful  beating  in  the  head  ; 
roaring  in  the  ears  ;  no  appetite,  or  morbid  desire  for 
all  kinds  of  food  ;  absence  of  thirst ;  pain  in  the  side 
and  region  of  the  liver  ;  great  sexual  inclination  ;  fre 
quent  dyspnoea ;  cough  with  mucus  expectoration  ; 
stitches  in  the  chest  and  side  ;  weakness  and  stiffness 
in  the  small  of  the  back  ;  restless  sleep,  with  frequent 
waking  ;  skin  tender  and  sensitive  ;  sweat  on  walk 
ing  ;  sensitiveness  to  cold  air  ;  weary,  faint,  and  dis 
couraged  ;  symptoms  worse  at  night  and  when  at  rest ; 
palpitation  of  the  heart,  and  intermittent  pulse. 

Mental  and  moral  symptoms. — Weakness  of  memory  ; 
inability  to  think  or  reason  ;  giddiness  from  walking  ; 
melancholy,  discouragement,  and  irritability. 

Remarks. — Chlorosis  of  nervous  and  delicate  females, 
with  a  thin  and  delicate  skin,  and  in  whom  menstru 
ation  has  always  been  irregular,  may  be  cured  by  se 
pia.  If  the  patient  sweats  profusely  when  walking, 
and  is  particularly  sensitive  to  cold  air,  this  remedy  is. 
still  more  necessary. 

In  inveterate  cases,  attended  with  extreme  prostra 
tion,  trembling  of  the  limbs,  coldness  of  the  surface, 
entire  suppression  of  the  menses,  dropsical  swellings, 
great  difficulty  of  breathing,  palpitation  of  the  heart, 
loose  state  of  the  bowels,  frequent  and  protracted  turns 
of  faintness,  we  may  examine  ferrum  arsen.  and  vera- 
trum.  Carb.  calc.  and  platina  are  indicated  when  the 
menses  are  too  frequent  and  abundant.  These  medi 
cines  are  especially  adapted  to  young  female  organ 
isms. 

Administration. — The  remedies  should  generally  be 


566  SCROFULA. 


employed  at  the  first,  second  and  third  attenuations,  and 
a  dose  administered  once  or  twice  daily,  until  there  is 
an  apparent  effect.  No  repetition  should  be  allowed 
so  long  as  the  slightest  amendment  is  perceptible. 


CHAPTER  XXX. 

SCROFULA. 

This  disease  was  described  by  the  Greeks  under  the 
appellation  *ot£u6ts,  from  xe7f«$,  hog,  and  by  the  Latins, 
(scrophules  from  scropha,  female  swine).  This  name 
had  its  origin  in  the  well-known  fact,  that  scrofula 
was  a  disease  peculiar  to  the  above  named  animal. 

The  blood  of  scrofulous  subjects  has  been  found  to 
differ  materially  from  that  of  healthy  individuals.  In 
the  former,  there  is  a  superabundance  of  serum  and  a 
deficiency  of  the  fibrous  portion,  and  the  solids  which 
are  generated  from  this  blood  are,  in  consequence, 
lax,  feeble,  and  incapable  of  resisting  exposure,  fa 
tigue  and  disease. 

Scrofula  is  for  the  most  part  hereditary,  but  the  phy 
sician  is  frequently  presented  with  well  marked  cases 
of  the  acquired  disease.  The  circumstances  which  fa 
vour  the  formation  of  an  original  scrofulous  dyscrasia, 
are,  cold  and  damp  habitations,  want  of  healthy  and 
nutritious  food,  constant  confinement  at  labour  in 
close  and  ill-ventilated  rooms,  and  finally,  the  use  of 
pork  in  all  its  forms  as  a  principal  article  of  food. 
Respecting  this  last  cause,  we  submit  a  few  remarks : 
Since  the  time  of  Moses,  a  large  portion  of  mankind 
have  looked  upon  the  swine  as  an  impure  animal,  un 
fit  for  food.  Its  impurity  consists  of  a  disorder  of  a 
purely  scrofulous  character  which  is  inherent  and  pe 
culiar  to  it,  and  is  constantly  being  developed,  espe 
cially  during  confinement  and  subjection  to  the  ordi 
nary  modes  of  feeding.  Probably  no  animal  is  more 
filthy  in  its  habits  or  more  disgusting  for  its  selection 


SCROFULA.  567 

of  food.  Let  the  pork-eater  contemplate  an  instant, 
the  customary  mode  of  rearing  the  domestic  swine, 
and  observe  what  offal,  filth,  putridity,  scourings  from 
everything  foul  and  corrupt,  constantly  swell  his  dis 
eased  carcase.  Let  him  see  in  the  slaughter  house, 
how  often  the  internal  organs  and  the  surface  of  the 
vile  carcases  will  be  studded  with  tuberculous  forma 
tions,  or  scrofula,  and  then  return  to  pork  "  like  a  dog 
to  his  vomit,"  if  he  chooses. 

A  strong  corroboration  of  our  views  is  found  in  the 
fact,  that  in  all  of  those  countries  where  the  swine  is 
forbidden  to  be  used  as  food,  scrofula  is  almost  un 
known.  The  same  law  obtains  with  the  Jews,  who, 
abiding  by  the  precepts  of  their  religion,  inhabit  almost 
every  climate  and  country,  and  are  scarcely  ever 
afflicted  with  scrofula. 

It  is  absurd  to  argue  that  flesh  contaminated  with 
the  scrofulous  miasm,  cannot  communicate  to  the 
healthy  body,  after  digestion,  its  morbid  particles. 
The  poison  pervades  every  atom  of  the  affected  flesh, 
and  no  washing  or  digestion  can  destroy  or  banish  the 
noxious  quality. 

Scrofula  is  most  common  in  temperate  latitudes, 
where  the  changes  of  temperature  are  abrupt,  and 
where  the  atmosphere  is  much  of  the  time  loaded 
with  moisture.  The  miasm  operates  upon  almost 
every  structure  :  glands,  skin,  ligaments,  membranes, 
muscles,  and  bones,  all  succumb  to  its  attacks. 

Diagnosis. — The  signs  which  are  supposed  to  indi 
cate  the  scrofulous  habit,  are,  precosity  of  intellect ; 
blonde  hair ;  light  complexion  ;  blue  eyes  ;  soft  and 
delicate  cheeks  ;  lips  thick  and  red  ;  "  frequent  swell 
ing  of  the  upper  lip  and  nose  ;"  edges  of  the  eyelids  red 
and  prone  to  inflammation  ;  scurf  and  eruptions  on  the 
scalp  ;  large  head  ;  sensitiveness  to  cold  ;  ends  of  the 
fingers  blunt  instead  of  tapering ;  muscles  soft  and 
flabby ;  strong  inclination  for  venereal  pleasures. 
These  marks  are  generally  supposed  to  characterize 
the  scrofulous  habit,  but  it  has  occurred  to  us  to  wit 
ness  far  more  cases  of  scrofula  in  individuals  the  very 
opposite  of  this  description ;  but  whether  or  not  this 
is  the  result  of  accident,  or  whether  an  erroneous  im 
pression  has  prevailed  upon  this  subject,  we  know  not. 


568  SCROFULA. 

Amongst  the  most  common  and  simple  manifestations 
of  scrofula  may  be  ranked,  glandular  swellings  of  the 
neck. 

These  enlargements  occur  very  frequently  during 
childhood,  in  the  form  of  what  are  vulgarly  termed, 
"  kernels,"  on  different  parts  of  the  neck.  They  are 
excited  into  activity  by  taking  cold,  by  currents  of  air 
upon  the  neck,  by  measles,  scarlatina,  and  whooping- 
cough,  and  either  remain  for  a  long  time  stationary 
and  inactive,  or  run  on  to  more  violent  inflammation 
and  suppuration.  These  swellings  sometimes  attain 
a  very  large  size,  involving  most  of  the  glands  of  the 
neck,  and  remain  in  this  condition  for  many  years. 
More  frequently,  however,  owing  to  injudicious  allo 
pathic  treatment,  the  swellings  are  dispersed^by  exter 
nal  applications,  the  malady  is  forced  to  embody  itself 
upon  the  lungs,  and  a  fatal  phthisis  pulmonalis  is  the 
result.  Another  form  in  which  scrofula  developes 
itself,  especially  in  children,  is  that  of 

Strumous,  or  Scrofulous  Ophthalmia. 

This  disease  is  characterized  by  extreme  sensitive 
ness  of  the  affected  organs  to  light.  Even  the  slight 
est  ray  causes  intense  pain,  and  the  little  patient 
makes  every  effort  to  avoid  exposure.  During  the  in 
flammation  an  eruption  usually  makes  its  appearance 
on  the  cheeks,  in  the  vicinity  of  the  eyes,  and  which 
often  extends  to  the  very  organs  themselves,  thus 
giving  rise  to  troublesome  and  dangerous  ulcers. 
These  ulcers  not  unfrequently  extend  until  the  struc 
ture  of  the  eye  becomes  so  far  impaired,  that  total 
blindness  ensues. 

The  next  form  of  scrofula  to  which  we  shall  call  at 
tention,  is  that  in  which  the  joints  become  affected. 
The  most  important  of  these  affections  are  the 

White  Swelling,  (Arthrocace),  and  the  Hip-disease. 

The  approach  of  these  maladies  is  commonly  grad 
ual  and  insidious.  Occasional  pains  are  complained 
of  in  the  diseased  joint,  after  exercise  ;  the  motions  of 
the  limb  gradually  become  impaired,  and  vague  pains 


SCROFULA.  569 

are  experienced  in  the  neighbouring  joints,  which 
sometimes  induce  the  belief  that  healthy  parts  are 
the  seat  of  the  inflammation.  As  the  disease  ad 
vances,  the  ligaments,  cartilages,  and  other  structures 
composing  the  joint,  become  so  much  thickened  by 
the  inflammatory  action,  that  the  limb  after  a  time 
becomes  stiff,  and  the  joint  immovable.  In  some  in 
stances  the  inflammation  is  arrested  at  this  point,  the 
suppurative  process  is  prevented,  and  a  recovery  by 
what  is  called  anchylosis  takes  place.  But  in  the  ma 
jority  of  cases  the  disorder  proceeds  on  to  suppura 
tion,  the  whole  structure  of  the  joint  becomes  involved 
in  this  action,  a  profuse  discharge  of  matter  takes 
place  from  the  part,  constitutional  disturbance  is 
manifest  in  the  form  of  emaciation,  debility,  night- 
sweats,  and  other  symptoms  of  hectic  fever,  and  the 
patient  soon  succumbs.  Scrofulous  affections  of  the 
joints  are  very  difficult  of  detection  in  their  early 
stages.  The  pains  are  so  vague  and  indefinite,  as 
scarcely  to  attract  attention  ;  there  is  little  or  no 
swelling  or  discoloration  over  the  disordered  part ; 
and  there  is  no  derangement  of  the  general  health 
which  indicates  that  the  organism  is  suffering  under 
a  serious  malady.  It  is  for  this  reason  that  the  dis 
ease  is  allowed  to  make  serious  progress  before  its 
true  nature  is  suspected.  Like  its  near  relative,  the 
consumption,  it  strikes  silently,  but  deeply  and  fatally. 
Another  scrofulous  disease,  common  in  infancy,  is 
known  as 


Strumous  Disease  of  the  Mesenteric  Glands. 

The  characteristic  signs  of  this  malady  are,  wasting 
of  the  limbs,  pale  and  attenuated  appearance  of  the 
skin,  tumefaction  and  tenderness  of  the  abdomen, 
sunken  eyes,  irregular  state  of  the  bowels,  variable 
appetite,  passage  of  partially  digested  food,  general 
irritability.  After  the  disorder  is  seated,  the  process 
of  absorption  is  suspended,  so  that  only  a  small 
amount  of  nutriment  arrives  at  the  blood,  and  the 
sufferer  is  soon  reduced  to  that  condition  which  med 
ical  men  recognise  as  marasmus. 

Although  the  mesenteric  glands  sometimes  suppu- 


570  SCROFULA. 

rate,  yet  much  more  frequently  the  victims  to  mesen- 
teric  disease  die  from  actual  starvation.  The  only 
hope  of  cure  in  these  cases  is,  a  detection  of  the  ma 
lady  at  its  onset,  and  the  services  of  a  thoroughly 
competent  physician. 

In  a  previous  chapter,  we  have  had  occasion  to 
treat  of  another,  and  perhaps  the  most  dangerous  form 
of  scrofula,  under  the  head  of  phthisis  pulmonalis,  or 
tubercular  consumption,  to  which  we  refer  the  reader. 

There  are  numerous  other  scrofulous  affections  of 
the  different  parts  of  the  organism,  as  the  brain,  the 
liver,  the  skin,  the  spleen,  and  the  spinal  marrow. 
The  admirable  works  of  Hartmann  and  Schoenlein 
may  be  consulted  with  advantage  with  reference  to 
this  subject. 

Hahnemann  has  included  scrofula  as  a  form  of 
psora,  but  evidently  on  insufficient  grounds.  Psora  is 
contagious,  scrofula  non-contagious.  The  matter  of 
a  psoric  eruption  is  capable  of  communicating  its 
similitude  by  inoculation  ;  that  of  scrofula  is  innoc 
uous  when  inoculated.  Psora,  in  its  specific  devel 
opment  upon  the  skin,  assumes  the  appearance  of  a 
vesicular  eruption  ;  scrofula  makes  its  appearance  in 
the  form  of  extensive  ulcers,  abscesses,  &c.  The 
psoric  miasm  exercises  its  specific  affinity  upon  the 
skin  ;  the  scrofulous  miasm  upon  the  glandular  sys 
tem.  Psora  is  no  respecter  of  persons,  but  attacks  all 
constitutions,  temperaments,  and  organizations  alike  ; 
scrofula  is  supposed  to  select  its  subjects  from  those 
who  are  daintily  formed,  and  possess  some  peculiari 
ties  of  organization ;  psora  is  readily  cured  by  anti- 
psorics ;  scrofula  always  requires  much  time,  and  is 
often  absolutely  incurable  by  any  course  of  treatment. 
Psora  cannot  be  artificially  acquired  by  any  particu 
lar  mode  of  life,  or  any  particular  food  ;  with  scrofula 
it  is  the  reverse.  Finally,  the  development  of  the 
psoric  miasm,  when  it  is  clear  and  apparent,  is  always 
specific  and  uniform,  viz.,  in  vesicular  eruptions  of  a 
peculiar  appearance  upon  the  surface,  and  the  ma 
lady  is  unequivocally  contagious ;  while  the  develop 
ment  of  the  scrofulous  miasm  is  subject  to  very  great 
variations,  but  for  the  most  part  attacking  the  glands, 
rather  than  the  skin,  and  decidedly  non-contagious. 


SCROFULA.  571 

Causes. — The  scrofulous  habit  is,  in  most  instances, 
inherited.  In  its  hereditary  subjects  we  may  notice 
from  birth  a  radical  unsoundness  of  constitution,  an 
irritability,  sensitiveness  to  slight  exposures,  prone- 
ness  to  catarrhal  difficulties,  and  an  inability  to  resist 
diseases,  which  is  not  apparent  in  healthy  children. 
The  acquired  scrofulous  habit  is  generally  amongst 
the  poor,  who  are  ill-fed,  clad,  and  housed.  We  have 
before  alluded  to  the  causes  which  especially  induce 
this  variety  of  the  disease ;  they  are  also  the  chief 
exciting  influences  of  the  hereditary  dyscrasia.  At 
mospheric  vicissitudes,  abuse  of  stimulants,  excesses 
in  venery,  onanism,  intestinal  irritation,  excessive 
mental  and  physical  occupation,  scarlatina,  measles, 
abuse  of  mercury,  iodine,  and  other  drugs  which  un 
duly  stimulate  the  glandular  system,  also  excite  the 
latent  disorder. 

Therapeutics. — It  has  been  observed  that  scrofulous 
persons  are  peculiarly  sensitive  to  cold,  and  that 
abrupt  changes  from  heat  to  cold,  in  a  moist  region, 
are  especially  calculated  to  call  into  active  operation 
the  latent  malady.  For  this  reason  it  behooves  those 
who  are  liable  to  the  affection,  whether  by  heredi 
tary  or  acquired  predisposition,  to  dwell,  if  possible,  in 
a  warm  and  equable  climate.  When  the  lungs  be 
come  affected,  this  course  will  often  be  necessary,  in 
order  to  save  life.  In  all  scrofulous  diseases,  too 
much  stress  cannot  well  be  laid  upon  the  importance 
of  a  mild,  dry,  and  uniform  temperature. 

The  food  of  scrofulous  subjects  should  always  be  of 
the  most  nutritious  character,  in  order  that  a  due  pro 
portion  of  fibrine  may  be  introduced  into  the  blood. 
Fresh  meats,  like  beef,  mutton,  venison,  fowls,  and 
veal,  should  constitute  the  principal  articles  of  food  ; 
and  bread,  rice,  and  other  farinaceous  substances, 
should  be  made  to  take  the  place  of  watery  and  suc 
culent  vegetables.  Porter,  ale,  and  light  wines  may 
also  be  used  moderately  with  advantage. 

Much  exercise  in  the  open  air  is  also  essential.  In 
taking  exercise,  it  is  of  the  utmost  importance  that 
the  mind  should  be  agreeably  occupied,  for  if  we  walk 
or  ride  as  a  task,  we  shall  obtain  very  little  benefit. 

Bathing,  both  in  fresh  and   salt  water,  is    also  a 


572  SCROFULA. 

means  of  securing  a  healthy  action  of  the  skin,  and  of 
imparting  tone  and  vigour  to  the  whole  system. 

The  clothing  should  always  be  adapted  to  the  sea 
son,  and  in  temperate  and  cold  latitudes  we  strongly 
advise  the  buckskin  wrapper,  to  be  worn  over  a  thin 
linen,  silk,  or  Canton  flannel  under-shirt.  We  com 
mend  the  use  of  these  garments,  during  the  winter, 
from  personal  experience. 

The  remedies  most  deserving  of  confidence  in  the 
treatment  of  scrofula,  in  its  various  forms,  are,  sul 
phur,  heparsulph.,  mercurius,  iodine,  baryta,  dulcamara, 
conium,  belladonna,  lycopodium,  sepia,  calcarea  carb., 
rhus  tox.,  aurum  mur.9  china,  ferrum  iodid.,  mere., 
oleum  jecoris  aselli. 

Sulphur. — External  indications. — Scrofulous  ulcers 
on  different  parts  of  the  surface  ;  humid  eruptions  be 
hind  the  ears  ;  purulent  discharges  from  the  ears ; 
scrofulous  ophthalmia  of  children,  with  eruptions 
about  the  eyes,  and  ulcers  on  the  cornea ;  chronic 
enlargement  of  the  tonsils  ;  enlarged  ovaria  ;  swelling 
of  the  axillary  glands  ;  swelled  nose  ;  frequent  nose 
bleed  ;  swelled  upper-lip  ;  swelling  of  the  glands  un 
der  the  lower  jaw  ;  enlargement  and  suppuration  of 
the  inguinal  glands  ;  swelling  of  the  posterior  cervical 
glands  ;  white  swelling  of  the  knee  ;  emaciation. 

Physical  sensations — Chronic  inflammation  of  the 
eye-lids ;  scrofulous  ophthalmia,  attended  with  great 
intolerance  of  light,  and  sense  of  fulness  and  disten- 
tion  of  the  lids  ;  pulmonary  cough,  with  sticking  pains 
in  the  chest,  and  copious  purulent  expectoration  ;  in 
flammation  and  pain  in  the  knee  and  hip-joints  ;  itch 
ing  pimples  upon  the  scalp,  and  pain  at  the  roots  of 
the  hairs ;  stitching  pains  in  the  ears  and  in  the  pa 
rotid  glands ;  painful  swelling  of  the  upper  lip  and 
wings  of  the  nose  ;  pain  in  the  region  of  the  liver 
after  exercise  ;  pain  in  the  abdomen  on  pressure,  and 
in  the  inguinal  glands  ;  sensation  of  weariness  and 
fatigue  in  all  the  limbs  ;  want  of  vitality  ;  sensitive 
ness  to  cold ;  pains  worse  during  cold  weather. 

Mental  and  moral  symptoms. — Despondency  alter 
nating  with  gayety  ;  irritable,  indolent,  and  discon 
tented. 


SCROFULA.  573 

Administration. — One  grain  of  the  third  trituration 
every  twenty-four  hours,  until  a  response  is  manifest. 

Rhus  tox. — External  indications.  —  Tinea  capitis  ; 
soft  tubercles  on  the  hairy  scalp  ;  scrofulous  ophthal 
mia,  with  photophobia,  and  an  eruption  about  the 
eyes ;  chronic  swelling  and  induration  of  the  parotid 
gland,  the  axillary,  and  other  glands ;  enlargement  of 
the  bones  ;  herpetic  and  moist  or  dry  scurfy  eruptions 
in  different  parts  of  the  body  ;  swelling  and  other 
signs  of  inflammation  in  the  hip  and  knee  joints. 

Physical  sensations. — Pain  in  the  hip  joint,  increased 
on  pressing  the  trochanter  major,  and  attended  with 
shortening  of  the  limb,  and  alternating  pains  in  the 
knee ;  pains  of  white  swelling,  and  scrofulous  affec 
tions  of  the  ancle  joint ;  scalp  painful  to  the  touch,  or 
from  moving  the  hair  backwards ;  inflammation  and 
tenderness  of  the  edges  of  the  eyelids;  eyes  sensitive 
to  light ;  eyelids  itch  and  feel  swollen  ;  crusty  erup 
tion  in  the  nose,  and  about  the  mouth  ;  repugnance  to 
bread  and  other  food ;  stitches  in  the  side  ;  short, 
anxious,  and  painful  cough  ;  oppression  of  the  chest ; 
glandular  swellings  painful  when  touched  ;  stiffness 
and  lameness  of  the  limbs  ;  very  sensitive  to  the  open 
air  ;  pains  worst  during  inaction,  or  in  the  cold  air. 

Mental  and  moral  symptoms. — 111  humour  ;  languor  ; 
disinclination  to  all  mental  or  bodily  exertion. 

Administration. — A  drop  of  the  third  dilution  each 
day,  as  long  as  may  be  deemed  necessary. 

Iodine. — External  indications. — Enlargement  of  the 
cervical,  parotid,  thyroid,  and  tonsil  glands  ;  scrofulous 
inflammation  of  the  knee,  with  swelling,  heat  and  red 
ness  ;  elongated  and  enlarged  uvula ;  induration  of  the 
os  uteri ;  glandular  indurations  in  different  parts  of  the 
body  ;  rough  and  dry  skin  ;  general  emaciation  ;  with 
hectic  appearance. 

Physical  sensations. — Catarrhal  affections  of  the 
mucous  membranes  depending  on  scrofula ;  swelling 
and  pain  in  the  liver  ;  inflammation  in  the  knee,  with 
stitches  and  burning,  and  increased  pain  on  motion  of 
the  joint  or  from  pressure  ;  contraction  of  the  oeso 
phagus  from  enlargement  and  inflammation  of  the 
glands  and  mucous  membrane,  with  stitching  pains 
during  deglutition  ;  enlarged  mesenteric  glands  ;  tumid 


574  SCROFULA. 

abdomen,  with  pains  on  pressure  ;  swelling  and  pain 
in  the  bronchial  glands  ;  glandular  swellings  about  the 
neck  and  axilla,  painful,  especially  on  pressure ; 
itching  pimples  on  the  arms  and  chest ;  general  de 
bility  ;  hectic  fever ;  pains  aggravated  by  exercise,  by 
contact  and  by  warmth. 

Mental  and  moral  symptoms. — Nervous  irritability 
and  increased  sensitiveness  to  external  impressions. 

Administration. — Same  as  rhus. 

Baryta  mur. — External  indications. — Chronic  indu 
ration  of  the  cervical  glands  ;  scrofulous  eruptions  and 
ulcerations  ;  tinea  capitis  ;  enlargement  of  the  liver, 
of  the  testes,  and  of  the  mammae  ;  chronic  inflamma 
tion  of  the  eyelids. 

Physical  sensations. — Itching  eruptions  of  the  scalp ; 
general  emaciation  and  debility  ;  scrofulous  disease  of 
the  throat,  aggravated  after  every  cold  ;  scrofulous 
affections  of  the  ears,  attended  with  throbbing  and 
itching,  and  discharge  of  purulent  matter  ;  inflamma 
tion  and  suppuration  of  the  tonsils ;  pains  in  the  af 
fected  joints  and  in  the  long  bones  ;  liability  to  sore 
throat  after  every  cold ;  disease  of  the  mesenteric  glands 
in  children  ;  pains  mostly  on  the  left  side,  when  sitting, 
and  relieved  by  exercise  in  the  open  air  ;  adapted  to 
old  men  and  young  children. 

Mental  and  moral  symptoms. — Imbecility  ;  absence 
of  mind  ;  impaired  intellectual  powers. 

Administration. — The  second  or  third  attenuation 
may  be  selected — a  dose  daily — until  the  requisite  im 
pression  is  produced. 

Dulcamara. — External  indications. — Moist  and  sup 
purating  herpes,  forming  crusts,  or  scurvy,  bran-like 
eruptions;  swellings  of  the  cervical  and  submaxillary, 
and  inguinal  glands;  swelling  of  the  calf  of  the  leg; 
emaciation  ;  scrofulous  inflammation  of  the  eyelids. 

Physical  sensations. — Pains  in  the  enlarged  glands, 
particularly  on  motion  ;  great  susceptibility  to  cold  ; 
pains  in  the  joints  on  exposure  to  cold ;  pains  worse 
during  rest  ;  paralysis  of  the  upper  eyelids ;  phthisis 
pulmonalis,  before  the  tubercles  commence  softening ; 
pulmonary  symptoms  brought  on  by  repeated  colds  ; 
pains  in  the  chest ;  febrile  symptoms  ;  lassitude  ; 
bruised  sensations. 


SCROFULA.  575 

Mental  and  moral  symptoms. — Disposition  restless, 
angry,  and  quarrelsome. 

Administration. — In  the  same  manner  as  baryta. 

Conium  mac. — External  indications. — Swelling,  in 
duration  and  suppuration  of  the  external  glands  ;  ma 
lignant  scrofula ;  caries  of  the  bones  ;  scrofulous 
photophobia  ;  diseased  rnesenteric  glands  in  children  ; 
enlargement  and  induration  of  the  liver  and  pancreas. 

Physical  sensations. — Scrofulous  swellings,  which 
evince  a  disposition  to  run  into  scirrhous  degenera 
tions  ;  pains  in  the  bones,  and  in  the  malignant  ulcer- 
ations;  inflammation,  swelling  and  pain  in  the  ovaries  ; 
painful  swellings  of  the  uterus  ;  pain  in  the  region  of 
the  liver,  when  walking;  purulent  expectoration  from 
softened  tubercles  ;  intolerance  to  light,  in  consequence 
of  scrofulous  opthalmia;  dull  pain  in  the  knee,  when 
stepping  ;  bruised  and  sore  feeling  in  the  calves  of  the 
legs  ;  pains  worse  during  rest,  and  in  the  night. 

Mental  and  moral  symptoms. — Dulness  of  intellect ; 
want  of  memory  ;  irritability. 

Remarks. — For  indurated  glands,  Dr.  Johannsen  as 
serts,  that  "conium,  in  the  second  dilution,  stands  high 
est  as  a  remedy,  and  next  to  it,  mercurius  so/." 

Administration. — We  advise  the  third  attenuation — 
a  dose  daily  until  its  effects  are  apparent. 

Belladonna.  —  External  indications.  —  Glandular 
swellings,  with  suppuration  ;  ulcers  ;  emaciation  ;  in 
flammation  and  swelling  of  the  bones  ;  eyelids  in 
flamed  ;  ulcers  upon  the  cornea  ;  photophobia  ;  swell 
ing  of  the  lips,  nose,  tongue,  uvula,  tonsils  ;  bleeding 
at  the  nose  ;  swollen  and  spongy  gums. 

Physical  sensations. — Inflammation  and  pain  in  the 
enlarged  glands,  and  in  the  periosteum  and  bones  ; 
diseased  mesenteric  glands,  with  atrophy;  inflamma 
tion  of  the  eyes,  with  heat,  redness,  and  great  intoler 
ance  to  light ;  pain  in  the  ball  of  the  eye  ;  double  vis 
ion  ;  roaring  in  the  ears  ;  painful  swelling  of  the  paro 
tid  gland  ;  soreness  of  the  throat ;  impeded  deglutition  ; 
lameness  of  the  limbs  when  moved ;  smarting  and 
burning  pains  in  the  hip  joint,  increased  by  contact  or 
motion,  and  during  the  night;  painful  ulcers  on  the 
skin  ;  sensitiveness  to  cold  air ;  adapted  to  the  scrofu- 


576  SCROFULA. 

lous  affections  of  children  and  females  of  a  mild  tem 
per. 

Mental  and  moral  symptoms. — irritability  ;  amorous, 
nervous,  excitable,  talkative. 

Administration. — Same  as  conium. 

Lycopodium. — For  the  scrofulous  dyscrasia,  and  es 
pecially  where  the  periosteum,  bones,  and  cervical 
glands  are  affected.  This  remedy  is  adapted  to  lym 
phatic  constitutions. 

Sepia  will  be  found  an  efficacious  remedy  in  scrofu 
lous  females,  who  are  troubled  with  irregularities  in 
the  menstrual  functions.  It  has  been  employed  suc 
cessfully  in  indurations  of  the  uterus,  corrosive  leu- 
corrhoea,  and  in  pulmonary  phthisis  with  profuse  puru 
lent  expectoration. 

Calcarea  carb. — According  to  Hahnemann,  carbon 
ate  of  lime  is  indispensable  in  those  cases  where  the 
menses  appear  too  early  and  are  too  profuse.  It  is 
also  appropriate  in  young  persons  of  scrofulous  habits. 
In  children  presenting  the  usual  marks  of  the  scrofu 
lous  dyscrasia,  it  is  one  of  our  most  valuable  remedies. 
It  is  highly  recommended  likewise  in  the  scrofulous 
ophthalmias  of  children,  particularly  after  ulcers  have 
formed  on  the  cornea.  Also  in  marasmus  arising  from 
diseased  mesenteric  glands,  it  is  an  admirable  remedy 
in  alternation  with  iodine.  Scrofulous  eruptions  and 
ulcers  of  children  often  yield  to  this  remedy,  after 
sulphur,  mercurius,  and  hepar  sulphuris  have  been  used 
in  vain. 

Hcpar  sulphuris  is  adapted  to  the  cure  of  scrofu 
lous  tumours  in  a  state  of  suppuration,  to  scrofulous 
ophthalmia  with  profuse  lachrymation,  and  much  mu 
cous  discharge  from  the  meibomian  glands,  and  in 
coxalgia,  after  a  purulent  discharge  has  occurred. 
This  medicine  is  proper  for  scrofulous  and  lymphatic 
constitutions. 

Mercurius. — This  remedy  is  advised  by  Hahnemann 
in  scrofula  combined  with  syphilis.  The  glandular  in 
flammations  will  be  characterized  by  a  diffused  red 
ness,  much  swelling,  and  gnawing,  stinging  or  darting 
pains,  worse  at  night  in  bed.  It  should  be  consulted 
in  affections  of  the  bones,  the  joints,  the  eyes,  and  in 
eruptions  and  ulcers  upon  the  surface.  The  following 


SCROFULA.  577 

preparations  of  mercurius,  we  especially  commend  in 
scrofula  :  mere,  sol.,  iod.  mere.,  and   mere,  prcecip.  rub. 

Aurum  mur.,  ferrum  and  china  are  worthy  of  consid 
eration  in  protracted  and  obstinate  cases,  where  the 
strength  of  the  patient  has  become  much  impaired, 
and  but  little  impression  has  been  made  by  the  previ 
ous  remedies. 

Hartmann  observes  that  he  has  "  derived  essential 
benefit  from  oleum  jecoris  aselli  in  every  form  of  the 
disease,  especially  in  the  precursory  stage,  when  no 
particular  organ  was  affected  :  the  patient  looked  pale, 
emaciated,  the  muscles  became  flabby,  the  patient 
showed  an  aversion  to  meat  and  vegetables,  and  want 
ed  to  eat  bread  and  butter  all  the  time.  I  gave  it  in 
teaspoonful  doses,  morning  and  evening,  almost  al 
ways  with  success.  In  scrofulous  affections  of 
bones  it  likewise  proved  useful,  but  less  so  in  other 
forms  of  the  disease." — (Hartmanrfs  Chronic  Diseases, 
vol.  iii.,  p.  54.) 

Dr.  J.  H.  Bennett,  of  London,  has  found  the  cod  liver 
oil  (oleum  jecoris  aselli)  of  great  service  in  scrofulous 
cases  characterized  by  general  or  local  atrophy.  But 
in  scrofulous  affections  in  which  the  general  health 
and  strength  are  unimpaired,  and  the  digestive  func 
tions  are  not  deranged,  Dr.  B.  advises  iodine.  We  have 
employed  the  oil  in  doses  of  a  drachm,  three  times  daily, 
with  eminent  success,  in  almost  every  form  of  scro 
fula. 

For  scrofulous  ulcers  with  callous  edges,  and  fistulas, 
silicea  alone,  or  in  alternation  \viihphosphorus,  acidphos. 
and  conium,  was  found  by  Dr.  Johannsen  most  useful. 

When  the  ulcers  are  greenish  and  offensive,  carbo 
veg.  or  mercurius  dulc.,  is  advised. 

In  scrofulous  ophthalmia,  indurated  glands,  and  dis 
eases  of  the  bones,  arsenicum,  conium,  mercurius  sol.,  car- 
bo  animal.  Jieparsulph,a,i].d  aurum,me  the  best  remedies. 

"  Arsenicum  is  one  of  the  most  important  remedies 
in  scrofula,  for  removing  indurations  of  the  glands, 
and  deformities  of  the  bones,  for  regulating  the  dis 
charges  from  the  bowels,  and  for  restoring  the  skin  to 
a  healthy  state.  Also,  in  scrofulous  ophthalmia  it  is 
of  great  service."  (Dr.  Johannsen.  Homoeopathic  Jour 
nal,  vol.  1,  No.  11.) 

25 


578  AFFECTIONS    OF    THE    EYE 

Afl ministration. — As  a  general  rule,  the  first  to  the 
third  attenuations  should  be  selected,  and  the  doses 
repeated  once  or  twice  daily,  until  a  satisfactory  im 
pression  is  produced  upon  the  affected  structures. 


CHAPTER  XXXI. 

AFFECTIONS  OF  THE   EYE  AND  ITS  APPENDAGES. 

SECTION  I. 

The  eye,  in  the  immediate  vicinity  of  the  brain,  con 
nected  with  this  organ  by  the  optic  nerve,  endowed 
with  numerous  delicate  membranes,  nerves  and  blood 
vessels,  with  its  lens,  its  aqueous  and  vitreous  humours 
to  conduct  and  modify  the  luminous  rays  in  their  pas 
sage  to  the  retina, — all  disposed  in  the  most  consum 
mate  manner  to  serve  the  end  designed, — may  be 
looked  upon  as  a  most  complex  and  perfect  optical 
instrument.  It  is  the  mirror  in  which  are  reflected  the 
various  tableaux  of  external  objects,  for  the  satisfaction 
of  the  soul  within,  causing  it  to  respond  to  such  im 
pressions  so  that  the  most  indifferent  spectator  may 
look  into  its  depths,  and  see  the  manifestations  of  the 
perceptive  faculties. 

The  impressions  of  external  objects,  derived  through 
this  medium,  constitute  our  principal  sources  of  know 
ledge  and  of  pleasure.  Without  this  faculty,  we  learn 
only  by  vague  comparisons,  suggested  by  touch,  taste, 
smell,  and  hearing,  by  which  all  our  conceptions  are 
more  or  less  perverted  and  indefinite.  It  is  through 
the  medium  of  vision,  that  the  child  first  acquires  a 
just  idea  of  colours,  distance,  proportion,  magnitude, 
&c.,  and  begins  to  reason  and  act  by  a  comparison  of 
his  different  impressions.  It  is  through  the  eye  alone 
that  we  appreciate  the  infinite  variety  of  expression 
in  the  '*  human  face  divine,"  and  become  incited  to 
sympathy,  love,  pity,  charity,  admiration,  fear,  hope, 
hate*  anger,  and  other  emotions  ;  that  we  enjoy  the 


AND    ITS    APPENDAGES.  579 

beauties  and  sublimities  of  nature  ;  that  we  become 
acquainted  with  the  wonders  of  art  and  science  ;  and, 
by  contrasting  objects  with  each  other,  that  we  are 
able  to  enrich  our  minds  with  whatever  elevates  us  in 
dignity  of  being  and  capacities  of  happiness. 

The  eye  is,  perhaps,  more  delicate  of  organization,  and 
yet,  from  its  situation,  more  exposed,  than  any  other, 
to  external  causes  of  disturbance.  How  important  then 
that  we  obtain  accurate  ideas  relative  to  its  structure 
and  functions,  and  the  disorders  to  which  it  is  liable, 
that  we  may  be  able  to  protect  it  when  well,  and 
promptly  to  cure  it  when  diseased. 

In  our  description  of  the  diseases  of  the  eye  and  its 
appendages,  we  shall  adopt  this  classification  : 

First.  Affections  of  the  tunica  conjunctiva,  or  outer 
covering  of  the  eye,  including — First,  acute  ophthal 
mia  ;  second,  chronic  ophthalmia  ;  third,  purulent  oph 
thalmia  ;  fourth,  gonorrhasal  ophthalmia  ;  fifth,  stru- 
mous  or  scrofulous  ophthalmia  ;  sixth,  granulated  lids; 
and,  seventh,  opacity  of  the  cornea. 

Second.  Affections  of  the  deeper  seated  structures 
of  the  eye,  including — First,  inflammation  of  the  cor 
nea  ;  second,  iritis ;  third,  amaurosis ;  fourth,  hy- 
dropthalmia,  or  dropsy  of  the  eye;  fifth,  cataract; 
and,  sixth,  fungus  hcematodes,  and  cancer  of  the  eye. 

Third.  Affections  of  the  appendages  of  the  eye, 
including  —  First,  hordeolum  or  stye;  second,  entro- 
pium,  or  inversion  of  the  eyelids  ;  third,  ectropium,  or 
eversion  of  the  eyelids  ;  and,  fourth,  fistula  lachry- 
malis. 

This  classification  is  deemed  sufficient  for  all  prac 
tical  purposes,  and  much  less  liable  to  lead  to  confu 
sion  than  one  more  extended.  We  shall  point  out  the 
prominent  affections  of  each  structure  of  the  eye,  and 
endeavour,  in  enumerating  the  causes,  to  make  the 
reader  acquainted  with  every  thing  of  interest  con 
nected  with  each  particular  subject. 

Ophthalmia  may  be  primitive  or  symptomatic, — 
acute  or  chronic, — and  its  causes,  local  or  constitu 
tional.  Its  manifestations  also  may  be  confined  to  the 
eye  itself,  or  sympathetic  symptoms  may  declare  them 
selves  in  the  head,  stomach,  and  other  parts  of  the 


580  AFFECTIONS    OF    THE    EYE 

economy.  These  developments  will  depend  much 
upon  the  constitution,  temperament  and  habits  of  the 
patient,  the  causes  which  have  operated  to  produce 
the  malady,  the  severity  of  the  inflammation,  and  the 
tissue  affected.  It  is  worthy  of  note,  however,  that 
when  a  particular  tissue  of  one  eye  is  diseased,  the 
corresponding  structure  of  the  other  eye  is  exceedingly 
prone  to  a  similar  morbid  action,  from  sympathy.  This 
may  be  accounted  for  from  the  fact  that  the  eye  re 
ceives  its  nerves  and  blood-vessels  directly  from  the 
brain,  by  which  the  sympathetic  communication  be 
tween  the  two  organs  is  rendered  very  rapid  and  in 
tense. 

Finally,  we  direct  special  attention  to  the  therapeu 
tical  connection  existing  between  morbid  conditions 
of  particular  tissues,  and  primitive  medicinal  symp 
toms,  upon  the  same  tissues,  in  health.  We  have 
already  a  few  specifics  which  impress  certain  struc 
tures  only,  and  we  trust  that  the  time  is  not  distant 
when  medicines  will  be  discovered  capable  of  acting 
surely  and  specifically  upon  each  separate  part  of  the 
eye  or  its  appendages.  Fortunately,  a  few  of  our 
drugs  have  a  wide  range  of  action  upon  the  visual 
organs,  so  that  we  shall  be  able,  even  now,  to  find 
specifics  which  correspond  with  almost  any  morbid 
symptoms  that  may  present  themselves. 


SECTION  II. 

AFFECTIONS     OF    THE    TUNICA     CONJUNCTIVA. 
ACUTE    OPHTHALMIA. 

Diagnosis. — One  of  the  first  local  signs  of  simple  in 
flammation  of  the  conjunctiva,  is  an  injection  with 
red  blood,  of  a  number  of  the  vessels  which  naturally 
admit  only  a  white  fluid.  This  gives  to  the  eye  that 
slight  appearance  of  redness  and  distention  of  vessels, 
which  characterizes  the  first  stage  of  acute  ophthalmia. 
The  eye  now  becomes  more  than  usually  sensitive  to 
light,  smoke,  and  dust  ;  tears  are  easily  excited  ;  a 
feeling  is  experienced  similar  to  that  produced  by  par 
ticles  of  sand  or  dust  lodged  under  the  upper  eyelid, 
causing  the  patient  to  constantly  rub  the  eye  in  order 


AND    ITS    APPENDAGES.  581 

to  remove  what  he  supposes  to  be  a  foreign  substance  ; 
a  sense  of  heat,  fulness,  stiffness  and  tingling  is  felt  in 
the  globe  and  edges  of  the  lids  ;  and  slight  pains  begin 
to  shoot  through  the  eye.  At  first  but  a  part  of  the 
vessels  become  injected,  but  as  the  inflammation  in 
creases,  the  anastomosing  branches  become  involved, 
until  finally  the  whole  eye  presents  a  uniform  appear 
ance  of  deep  redness,  swelling,  and  turgidity.  At  this 
period  of  the  disease,  the  functions  of  the  eye  are  all 
more  or  less  perverted  ;  there  are  acute  pains  in  the 
ball ;  great  intolerance  to  light  ;  a  profuse  secretion 
of  scalding  tears  ;  disordered  vision  ;  agglutination 
of  the  lids  in  the  morning  from  matter  secreted  by 
the  meibomian  glands ;  intense  pain  on  moving  the  lids  ; 
distressing  sense  of  distention,  weight,  and  rigidity  of 
the  whole  organ,  and  diminished  power  of  motion.  , 

The  symptoms  thus  far  detailed,  are  purely  local 
and  include  all  of  the  symptoms  which  are  present 
from  the  commencement  to  the  termination  of  many 
cases  of  simple  acute  ophthalmia.  But  in  the  majority 
of  instances,  the  whole  system  sympathises  with  the 
local  affection,  and  we  are  presented  with  the  follow 
ing  additional  train  of  constitutional  or  sympathetic 
symptoms :  acute  pains  extending  from  the  eye  into 
the  temples  and  anterior  portion  of  the  brain ;  slight 
chills,  followed  by  accelerated  circulation  and  respi 
ration  ;  hot  and  dry  skin  ;  determination  of  blood  to 
the  head  and  face  ;  nausea ;  loss  of  appetite  ;  lassi 
tude  ;  general  irritability  ;  physical  weakness  ;  and 
other  indications  of  febrile  excitement. 

During  the  progress  of  the  inflammation,  a  peculiar 
appearance  is  often  observed  above  the  cornea,  in  the 
form  of  a  circular  elevation  termed  chemosis.  This 
arises  from  the  precaution  which  nature  has  taken  to 
protect  the  cornea  from  the  injurious  effects  of  ophthal 
mia,  by  fixing  the  conjunctiva  more  firmly  upon  this 
portion  of  the  globe,  than  upon  the  other  parts.  By 
this  peculiar  construction,  the  distention  of  vessels  and 
effusions  resulting  from  violent  inflammations,  are 
principally  manifested  in  the  first  instance,  without 
the  cornea,  and  thus  in  some  measure  protecting  this 
important  part  from  the  injury  it  might  otherwise 
sustain. 


582  AFFECTIONS    OF    THE    EYE 

The  severity  of  the  symptoms  will  depend  much 
upon  the  constitution  of  the  patient,  and  the  nature  of 
the  exciting  cause.  The  disease  may  terminate  in  a 
cure,  without  any  marked  alteration  in  the  appear 
ance  of  the  eye,  or  it  may  result  in  effusion,  caus 
ing  an  elevation  of  the  conjunctiva  above  the  cornea; 
or  in  adhesion  of  some  portion  of  the  conjunctiva 
covering  the  cornea,  and  giving  rise  to  those  appear 
ances  known  as  nebula,  albugo,  leucoma,  and  opacity ; 
or  in  suppuration,  from  the  surface  of  the  conjunctiva  ; 
or  in  ulceration  of  some  part  of  the  cornea ;  or  in 
sloughing  of  the  cornea.  These  appearances  will  be 
more  particularly  described  in  our  article  on  opacity 
of  the  cornea. 

Causes. — Undue  exposure  to  intense  heat  or  cold  ; 
inordinate  use  of  the  eyes  by  a  glaring  or  dim  light  ; 
the  application  to  the  eyes  of  irritating  foreign  sub 
stances  ;  mechanical  injuries  ;  extension  of  contigu 
ous  inflammations  to  the  eyes  ;  sudden  changes  of 
temperature  ;  metastases  of  gout  and  rheumatism. 

Prognosis. — If  appropriate  remedies  are  adminis 
tered  in  the  early  stage  of  the  complaint,  and  before 
any  organic  lesion  has  taken  place,  we  may  gener 
ally  predict  a  speedy  and  perfect  cure.  On  the  con 
trary,  if  effusion,  ulceration,  or  the  adhesive  process 
of  the  conjunctiva  over  the  cornea,  has  commenced, 
we  must  be  more  guarded  in  our  prognosis,  for  under 
these  circumstances  the  malady  often  ends  either 
in  impaired  vision,  or  a  total  loss  of  sight. 

Much  information  may  be  derived  respecting  the 
probable  termination  of  the  malady,  by  a  careful  ex 
amination  of  the  causes  which  have  been,  or  may  still 
be  in  operation,  and  of  the  temperament  and  constitu 
tion  of  the  patient.  For  example,  an  individual  of  an 
irritable  and  nervous  temperament,  and  of  a  delicate 
organization,  may  be  affected  with  the  most  violent 
local  and  constitutional  symptoms  for  a  considerable 
period,  without  endangering  the  integrity  of  the  eye  ; 
while  a  sanguine,  plethoric,  and  robust  patient  might 
experience  no  constitutional  effects,  and  but  moderate 
local  symptoms,  and  yet  speedily  suffer  from  serious 
disorganization  of  one  or  more  of  the  tissues.  Much 
will  also  depend  upon  our  ability  to  remove  all  causes 


AND  ITS  APPENDAGES.  583 

which  may  have  conduced  to  the  complaint,  and  to 
enforce  upon  our  patients  the  necessary  restraints  and 
attention  during  the  treatment. 

Therapeutics. — The  first  therapeutical  indication  is 
to  confine  the  patient  to  an  apartment  in  which  the 
light  is  mostly  excluded.  It  must  be  remembered  that 
this  natural  stimulus  of  the  healthy  eye,  becomes, 
during  an  acute  inflammation  of  its  tissues,  a  powerful 
irritant — a  morbid  agent  capable  of  aggravating  and 
perpetuating  the  disease.  As  the  inflamed  stomach 
cannot  tolerate  its  natural  stimulus,  the  food,  so  the  in 
flamed  eye  cannot  endure  with  impunity,  its  ordinary 
stimulus,  the  light.  Perfect  cleanliness  should  be 
enjoined,  and  an  exclusion  of  all  dust,  vapours,  smoke, 
and  bright  rays  of  light.  In  making  applications  to 
the  eye,  great  care  should  be  taken  to  avoid  compres 
sion  of  the  inflamed  part,  in  order  that  the  circulation 
may  remain  unobstructed,  and  that  sufficient  air  may 
be  admitted  to  the  parts. 

Respecting  local  applications,  we  entertain  the  most 
exalted  opinion  of  cold  water.  This  may  be  applied 
by  means  of  a  few  folds  of  soft  linen  cloth,  which  may 
be  frequently  dipped  in  the  water,  and  after  being 
partly  wrung  out,  laid  loosely  over  the  eye  and  the  sur 
rounding  parts.  This  application  may  be  persisted 
in  at  suitable  intervals,  until  the  active  symptoms  have 
subsided,  and  a  state  of  sub-acute  inflammation  occurs, 
when  recourse  may  be  had,  if  deemed  necessary,  to 
collyria  of  a  slightly  stimulating  character,  like  weak 
solutions  of  zinc,  nit.  argenti,  lead,  or  copper.  In  mak 
ing  use  of  these  last  named  articles,  we  should  only 
employ  a  strength  sufficient  to  create  a  decided  medi 
cinal  action,  and  omit  the  application  when  this  effect 
is  apparent,  and  so  long  as  the  consequent  reaction  or 
amendment  continues  ;  for  external  remedies,  when  ju 
diciously  employed,  are  subject  to  the  same  laws  of 
primary  and  secondary  action,  as  when  administered 
internally.  We  shall  say  more  upon  this  subject  under 
chronic  ophthalmia. 

The  medicines  to  which  we  call  particular  atten 
tion  are,  belladonna,  aconite,  arsenicum,  sulphur,  digi 
talis,  euphrasia,  pulsatilla,  arnica,  spigelia,  mercurius 
sol.,  graphite,  lycopodium. 


K     OF  TH- 

UNIVERSITY 

/-%  C  *. 


584  AFFECTIONS    OF    THE    EYE 

Belladonna.  —  External  indications.  —  Redness, 
swelling,  and  protrusion  of  the  ball  of  the  eye  ;  che- 
mosis  ;  swelling  of  the  lids  ;  frequent  discharge  of 
hot  and  salt  tears,  or  dryness  of  the  eyes  ;  spasmo 
dic  closure  of  the  lids;  flushed  cheeks;  throbbing  of 
the  carotid  and  temporal  arteries ;  full  and  rapid 
pulse  ;  hot  and  dry  skin. 

Physical  sensations. — Great  intolerance  to  light; 
pain,  burning,  and  smarting  in  the  eyes ;  heaviness, 
pressure  and  throbbing  in  the  ball  and  lids  ;  sharp 
pains  in  the  orbits,  extending  into  the  brain  ;  tearing 
pains  in  the  eyes  from  within,  outwards  ;  dimness  and 
obstruction  of  vision ;  spasmodic  sensations  in  the 
eyes. 

Mental  and  moral  symptoms. — Nervousness  ;  irrita 
bility  ;  disinclination  to  mental  labour. 

Remarks. — Belladonna  is  suitable  in  ophthalmia  oc 
curring  in  sanguine  and  irritable  persons,  from  con 
gestions  of  blood  to  the  eyes  in  consequence  of  ex 
posure  to  cold,  excessive  use  of  the  eyes,  metastases  of 
rheumatism  and  gout.  It  is  particularly  useful  when 
constitutional  symptoms  show  themselves  in  the  form 
of  acute  or  throbbing  pains  in  the  head  and  temples, 
hot  skin,  rapid  pulse,  flushed  cheeks,  dilated  pupils, 
and  perverted  vision. 

Aconite. — External  indications. — Vessels  of  the  con 
junctiva  injected  with  red  blood  ;  lids  red  and  swollen  ; 
chemosis  ;  dilation  of  the  pupils  ;  lachrymation,  worse 
on  the  slightest  exposure  to  light,  dust,  or  smoke  ;  pho 
tophobia  ;  flushed  cheeks  ;  hard  and  rapid  pulse  ;  hot 
and  dry  skin,  and  other  febrile  symptoms. 

Physical  sensations. — Very  great  intolerance  to  light ; 
pressing,  stinging,  burning,  or  exceedingly  acute  pains 
in  the  eyes  ;  eyeball  feels  bruised,  and  pressed  into 
the  orbit  ;  stinging  and  smarting  of  the  lids  ;  eyes 
very  hot,  and  filled  with  scalding  tears,  or  preterna- 
turally  dry  ;  pressure,  or  sharp,  beating,  or  stinging 
pains  in  the  head  and  temples ;  impaired  vision,  as 
from  a  gauze  before  the  eyes  ;  general  febrile  disturb 
ance. 

Mental  and  moral  sy7nptoms. — Much  mental  excite 
ment  ;  fear  and  apprehension  in  regard  to  the  probable 
result  of  the  case. 


AND    ITS    APPENDAGES.  585 

Re?narks. — This  remedy  is  particularly  called  for 
when  the  local  inflammation  is  very  intense,  and  the 
constitutional  symptoms  run  high.  It  operates  most 
happily  in  plethoric,  bilious,  and  sanguine  individuals, 
who  are  subject  to  determinations  of  blood  to  the  face, 
head,  and  lungs.  It  is  appropriate  in  ophthalmias 
caused  by  colds,  by  the  introductions  of  foreign  sub 
stances  into  the  eye,  and  by  rheumatism  and  gout. 

Arsenicum.  —  External  indications.  —  Conjunctiva 
much  congested,  and  of  a  dark-red  colour  ;  osdematous 
swelling  of  the  lids  ;  profuse  lachrymation  ;  tears  hot 
and  corrosive  to  the  cheeks  ;  lids  dry  and  red  ;  eyelids 
partially  closed  from  the  great  swelling ;  nightly  ag 
glutination  ;  spasmodic  movements  of  the  lids,  on  ex 
posure  to  light ;  ulcers  on  the  cornea. 

Physical  sensations. — Sensation  as  if  sand  had  be 
come  lodged  in  the  eye  ;  tearing,  burning,  or  stinging 
in  the  ball  and  lids,  aggravated  by  motion,  or  on  ex 
posure  to  light ;  throbbing  in  the  eyes  when  lying 
down  ;  impaired  vision ;  weakness,  weariness,  and 
tremour  of  the  lids  ;  great  intolerance  to  light ;  con 
stant  inclination  to  rub  the  eyes. 

Mental  and  moral  symptoms. — Mind  weakened,  and 
whole  system  rendered  nervous  and  irritable,  by  pain 
and  suffering. 

Remarks. — Arsenicum  is  applicable  to  those  cases 
which  arise  in  weakly  and  nervous  constitutions, 
where  the  pains  are  severe,  and  the  disease  is  unusually 
obstinate.  In  this  variety  of  ophthalmia,  the  local  and 
sympathetic  symptoms  are  very  troublesome,  but  there- 
is  much  less  danger  of  serious  organic  lesions  than  in 
most  other  forms  of  the  malady.  It  is  advised  in 
ophthalmia  arising  from  cold,  rheumatism  and  gout. 

Sulphur. — External  indications. — Injection  of  the 
vessels  of  the  conjunctiva ;  redness  and  swelling  of 
the  lids  ;  lachrymation,  or  preternatural  dryness  of  the 
eyes  ;  morning  agglutination  of  the  lids ;  photopho 
bia ;  eyes  swollen  and  prominent;  cornea  dim;  lids 
oadematous  ;  distention  of  the  conjunctiva  from  effusion. 

Physical  sensations. — Pressure  of  the  eyeballs,  worse 
on  moving  them  ;  pressure,  burning,  and  itching  of 
the  lids  ;  intolerance  to  the  rays  of  the  sun  ;  twitching 
of  the  lids;  trembling  of  the  eyes  ;  painful  dryness  of 


586  AFFECTIONS    OF    THE    EYE 

the  margins  of  the  lids  ;  bruised  feeling  of  the  eyes, 
on  motion ;  sensation  of  sand  under  the  upper  lid,  on 
motion;  dimness  of  sight. 

Mental  and  moral  symptoms. — Sensitive  ;  despond 
ent  ;  out  of  humour. 

Remarks. — Sulphur  is  adapted  to  lymphatic  tem 
peraments — a  scrofulous  or  psoric  dyscrasia,  and  may 
be  employed  in  ophthalmia  caused  by  repelled  erup 
tions,  abuse  of  mercury,  or  irritating  matters  intro 
duced  into  the  eye. 

Digitalis. — External  indications. — In  tense  redness  of 
the  conjunctiva ;  inflammation  of  the  meibomian  glands ; 
swelling  of  the  lids  ;  constant  and  profuse  lachryma- 
tion  ;  photophobia  ;  dryness  of  the  nose  ;  morning  ag 
glutination  of  the  lids  ;  tears  hot  and  corrosive  ;  coun 
tenance  bloated. 

Physicial  sensations. — Aching,  throbbing,  burning, 
pressing,  or  stitching  pains  in  the  affected  eyeball, 
worse  when  moving  or  touching  it ;  feeling  as  of  sand 
under  the  lids  ;  discharge  of  hot  and  irritating  tears, 
on  exposure  to  the  open  air  or  to  light ;  intolerance 
to  light ;  dimness  of  sight ;  eyes  constantly  hot  and 
painful ;  objects  all  appear  unnatural ;  visions  before 
the  eyes. 

Mental  and  moral  symptoms. — The  predominant 
mental  traits  are,  despondency  and  mental  languor. 

Remarks. — Digitalis  is  suited  to  sanguine  tempera 
ments,  and  also  to  persons  of  a  scrofulous  habit.  It 
has  been  successfully  employed  in  ophthalmias  conse 
quent  on  colds,  scrofula,  and  gout.  Euphrasia  also 
corresponds  to  most  of  the  symptoms  enumerated  un 
der  digitalis,  and  may  sometimes  be  substituted  to 
advantage  in  the  place  of  this  last  remedy,  when  the 
desired  effect  is  not  promptly  produced. 

Pulsatilla  is  appropriate  in  catarrhal  or  rheumatic 
ophthalmia,  attended  with  pressure  and  burning  in  the 
eyes,  as  if  from  sand  ;  redness  and  swelling  of  the  con 
junctiva  and  lids  :  coryza  ;  profuse  lachrymation  in 
the  wind  or  open  air  ;  burning  and  itching  of  the  eyes, 
inducing  a  disposition  to  rub  them  ;  photophobia ;  in 
flammation,  and  secretion  of  mucus  from  the  meibomian 
glands  ;  dimness  of  sight ;  morning  agglutination. 
Arnica  is  indispensable  in  ophthalmic  inflammations 


AND     ITS    APPENDAGES.  587 

caused  by  mechanical  injuries  of  the  eye,  or  of  the 
parts  in  its  vicinity.  The  remedy  may  be  used  both 
internally  and  externally. 

Spigelia  is  especially  adapted  to  rheumatic  and  ar 
thritic  ophthalmia  ;  the  pains  are  of  a  pressive  or 
stitching  character,  and  aggravated  by  movement ; 
the  vessels  of  the  conjunctiva  are  much  congested  ; 
the  cornea  is  dim ;  aching  pains  are  experienced  in 
the  eye  when  touched,  extending  deep  into  the  orbit ; 
the  upper  lids  swollen  and  stiff. 

Mercurius  sol.  is  proper  in  catarrhal  and  rheu 
matic  ophthalmia.  Its  indications  are,  inflammation 
of  the  eyes,  attended  with  burning,  smarting,  heat, 
and  pressure,  worse  in  the  open  air ;  sensation  as  if 
sand  were  under  the  upper  lid  ;  profuse  lachrymation  ; 
photophobia  ;  darting  pains  in  the  eyeballs  ;  redness 
and  swelling  of  the  lids ;  dimness  of  vision ;  pains 
worse  when  moving  or  touching  the  eye  ;  boring  pains 
in  the  eyes  and  surrounding  parts. 

Other  remedies  are,  graphite,  lycopodium,  nux  vomica, 
calcarea  carb.,  colocynth,  rhus,  cocculus,  cannabis,  and 
dulcamara,  to  which  the  reader  is  referred. 

Administration. — In  very  acute  cases,  we  advise  the 
third  attenuation,  and  a  repetition  of  the  dose  every 
two  hours  until  the  desired  impression  is  produced. 
In  more  mild  forms  of  the  disease,  we  use  the  first  or 
second  attenuations,  and  repeat  every  six  or  eight 
hours,  as  long  as  is  deemed  necessary. 

SECTION  III. 

CHRONIC    OPHTHALMIA. 

Chronic  ophthalmia  may  arise  in  consequence  of 
the  subsidence  of  the  active  symptoms  of  the  acute 
form  of  the  disease,  and  the  persistence  of  a  condition 
of  sub-acute  inflammation,  or  from  causes  which  ope 
rate  gradually,  and  induce  an  atonic  state  of  the  parts, 
and  a  low  grade  of  morbid  action.  It  may  continue 
in  this  chronic  state  for  years,  without  causing  any 
notable  organic  derangement,  the  only  difficulty  ex 
perienced,  being  a  weak,  sensitive,  and  irritable  con 
dition  of  the  eyes. 

Diagnosis, — When  chronic  ophthalmia  succeeds  the 


588  AFFECTIONS    OF    THE    EYE 

acute,  it  will  be  found  that  a  part  of  the  vessels  of  the 
conjunctiva  have  recovered  their  tone  and  now  circu 
late  only  the  white  blood,  as  formerly,  while  the  lar 
ger  vessels  remain  injected  with  red  blood.  These 
larger  vessels,  during  the  progress  of  the  disorder,  be 
come  so  much  distended  by  the  intromission  of  the  red 
globules,  that  a  varicose  dilatation  often  remains  for 
a  long  period  after  the  acute  stage  has  been  passed, 
and  thus  establishes  the  chronic  malady.  One  of  the 
prominent  local  symptoms,  therefore,  of  chronic  oph 
thalmia,  as  distinguished  from  the  acute  variety,  is, 
the  moderately  congested  state  of  the  vessels,  which 
renders  the  conjunctiva  partly  red  and  partly  white. 
The  eye  is  also  much  less  sensitive  to  light,  dust,  and 
smoke  ;  tears  are  not  so  easily  excited  ;  vision  is  im 
proved  ;  there  is  an  absence  of  pain,  burning,  and  heat ; 
tears  are  not  so  hot  and  acrid  ;  the  swelling  of  the  lids 
is  diminished,  and  all  febrile  and  sympathetic  symp 
toms  have  disappeared.  But  the  eye  is  more  sensitive 
than  natural  to  light ;  the  edges  of  the  lids  are  red  or 
purple  ;  nightly  agglutination  occurs  ;  the  patient  is 
unable  to  use  the  eyes  long  at  a  time  ;  objects  often 
float  before  the  eyes,  obstructing  vision  ;  the  lids  itch 
and  tingle,  mostly  in  the  morning  on  rising  ;  flow  of 
tears  caused  by  cold  air,  light,  wind,  smoke,  dust,  and 
vapours. 

Causes. — Acute  inflammation  ;  habitual  intemper 
ance  ;  constant  exposure  to  irritating  vapours ;  me- 
tastases  of  rheumatism  and  gout ;  external  injuries  ; 
repelled  eruptions  ;  protracted  exposure  to  cold  in  a 
region  of  snow  ;  excessive  use  of  the  eyes  by  a  strong 
or  dim  light. 

Prognosis. — Unless  adhesions  have  taken  place  be 
tween  the  conjunctiva  and  cornea,  or  ulcers,  cica- 
trixes,  or  effusions,  have  formed,  so  as  to  obstruct  the 
rays  of  light,  we  may  expect  a  ready  cure  of  the  dis 
ease.  If,  however,  disorganization  has  already  occur 
red,  and  vision  has  become  obstructed,  we  may  predict 
a  cure  of  the  morbid  inflammatory  action,  but  only  a 
partial  restoration  of  sight.  Habitual  chronic  ophthal 
mias,  proceeding  from  intemperance,  constant  expo 
sure  of  the  eyes  to  stimulating  vapours,  etc.,  may 
readily  be  cured  by  removing  the  exciting  causes,  and 


AND    ITS    APPENDAGES.  589 

having  recourse  to  the  appropriate  local  and  internal 
remedies. 

Therapeutics. — It  is  in  this  variety  of  ophthalmia, 
that  we  may  expect  to  derive  most  benefit  from  the 
use  of  stimulating  collyria.  The  object  of  all  remedies, 
as  has  before  been  observed,  is  to  create  a  healthy 
medicinal  action  in  the  diseased  part,  which  shall  su 
persede  the  morbid  action,  and  thus  secure  a  cure. 
But  we  have  also  seen  that  this  medicinal  effect  must 
be  two-fold  in  order  to  prove  curative  :  or,  in  other 
words,  there  must  be  a  primary  and  a  secondary  effect, 
the  former  analogous  to  that  of  the  disease,  and  the 
latter,  the  reverse,  or  curative.  Whenever  these  two 
conditions  result  from  the  application  of  remedies,  in 
ternal  or  local,  a  cure  may  be  expected.  Care,  how 
ever,  must  always  be  observed,  that  the  medicines  be 
so  adapted  to  the  nature  of  the  case,  that  the  primary 
symptoms  shall  be  of  short  duration,  and  succeeded 
by  the  legitimate,  opposite,  or  curative  reaction. 

In  deciding,  therefore,  respecting  the  proper  strength 
of  a  local  application  to  an  inflamed  eye,  we  may  fol 
low  the  maxims  of  Hahnemann,  or,  what  will  answer 
as  well,  adopt  the  following  rule  inculcated  by  Sir 
Astley  Cooper,  in  regard  to  the  use  of  collyria,  viz  : 
"  To  judge  how  far  the  stimulus  may  be  carried,  the 
criterion  is  exceedingly  simple  ;  if  you  find  that  a  cer 
tain  degree  of  smarting  and  pain  is  produced,  which 
soon  subsides  and  leaves  the  patient  much  more  easy 
than  before,  you  may  be  convinced  that  the  collyrium 
is  beneficial  ;  if,  on  .the  other  hand,  the  patient  expe 
riences  a  great  degree  of  pain,  which  does  not  subside 
speedily,  and  the  vessels  become  turgid,  you  may  be 
assured  that  the  collyrium  is  doing  harm,  and  that  the 
quantity  of  stimulus  ought  to  be  diminished." 

The  best  local  stimulus  we  ever  employed,  in  clearly 
pronounced  chronic  inflammation  of  the  eyes,  is  the 
wine  of  opium,  (vinum  opii),  a  single  drop  to  be  intro 
duced  into  the  eye  once  or  twice  in  twenty-four  hours, 
until  there  is  a  permanent  reaction.  When  the  se 
condary  symptoms  do  not  speedily  appear  after  the 
application,  we  may  then  have  recourse  to  a  weak 
solution  of  sulphate,  of  zinc,  or  of  nitrate  of  siloer.  If 
these  fail,  a  dilution  of  aconite  may  be  tried. 


590  AFFECTIONS    OF    THE    EYE 

The  internal  remedies  are,  arsenicum,  belladonna, 
calcarea  carbonica,  sulphur,  rhus,  silicea,  nux  vomica, 
graphite,  phosphorus. 

The  indications  for  the  use  of  these  different  medi 
cines  will  be  found  under  acute  ophthalmia.  The  prin 
cipal  difference  between  the  two  forms  of  the  malady, 
consists  in  degree  rather  than  in  the  quality  of  the 
symptoms. 

Respecting  the  administration  and  repetition  of 
doses,  we  prefer  the  first,  second,  and  third  attenua 
tions,  and  advise  a  repetition  once  in  twenty-four 
hours,  until  an  impression  is  produced. 

SECTION  IV. 

PURULENT    OPHTHALMIA. 

Diagnosis. — This  variety  of  ophthalmia  is  more  vio 
lent  and  destructive,  and  runs  its  course  with  much 
greater  rapidity,  than  that  which  we  have  described. 
It  is  characterized  by  a  profuse  purulent  secretion 
from  the  conjunctiva,  which  collects  and  hardens 
about  the  lids,  gluing  them  together,  and  in  this  way 
acts  as  a  constant  irritant  to  the  inflamed  part.  The 
disease  commences  like  the  simple  acute  ophthalmia, 
with  itching,  stinging,  or  burning  sensations  in  the 
lids  and  globe,  lachrymation,  sensitiveness  to  light,  red 
ness  of  the  conjunctiva,  which  soon  increase  to  an  in 
tense  villous  redness,  swelling  of  the  lids,  sensations  as 
if  foreign  substances,  like  sand  or  sticks,  were  in  the 
eye,  and  more  or  less  indistinctness  of  vision.  These 
symptoms  augment  very  rapidly  in  intensity.  The 
tingling  sensations  change  to  severe  pains  through  the 
eye,  sometimes  extending  to  the  temples,  and  even  the 
brain  itself;  there  is  chemosis,  the  lachrymation  be 
comes  changed  into  a  profuse  secretion  of  pus,  either 
yellow  or  greenish  ;  the  intolerance  to  light  becomes 
more  marked,  the  lids  are  very  much  swollen,  and 
discharge  much  purulent  matter,  and  there  is  almost  a 
total  obstruction  of  sight.  Constitutional  symptoms 
frequently  occur,  as  in  simple  ophthalmia,  in  the  form 
of  headache,  nausea,  quick  pulse,  hot  skin,  general 
prostration,  &c.  This  acute  stage  terminates  in  a 
short  period  in  a  sub-acute  inflammation,  or  in  ulcer- 


AND    ITS    APPENDAGES.  591 

ation  and  sloughing.  When  the  former  termination 
happens,  there  is  a  gradual  subsidence  of  all  the 
symptoms,  and  the  disease  remains  for  an  indefinite 
period  in  this  atonic  state,  after  which  the  eye  may 
recover  its  tone  and  healthy  function.  But  if  sloughing 
takes  place,  the  destructive  process  may  run  on  to  a 
total  destruction  of  the  part,  unless  energetic  mea 
sures  are  used  to  arrest  its  progress. 

Causes. — Sudden  alternations  from  heat  to  cold  ; 
endemic  and  epidemic  influences  ;  the  irritation  of 
hot  sand  introduced  into  the  eyes  ;  metastases  of 
rheumatism,  gout,  scarlatina,  small-pox,  and  measles ; 
abuse  of  mercury  ;  the  morbid  vaginal  secretion  to 
which  the  eyes  of  new-born  children  are  sometimes 
exposed. 

SECTION   V. 

GONORRHGEAL  OPHTHALMIA. 

Diagnosis. — This  variety  of  inflammation  attacks 
the  conjunctiva  also,  and  is  attended  with  symptoms 
very  similar  to  those  of  purulent  ophthalmia,  but  of 
much  greater  intensity.  This  disease  is  supposed  to 
be  the  most  violent  and  destructive  of  any  to  which 
the  eye  is  subject,  and  it  is  not  uncommon  so  see  it 
proceed  to  the  entire  destruction  of  vision,  notwith 
standing  the  most  early  and  energetic  attempts  to  cure 
it.  There  is  especial  danger,  in  gonorrhoeal  ophthal 
mia,  of  a  speedy  formation  of  ulcers  of  the  cornea, 
and  of  rapid  sloughing  through  the  tunics  of  the  eye. 
Whenever,  therefore,  we  are  called  to  a  case  of  this 
description,  with  intense  inflammation  and  redness  of 
the  eyes,  greatly  swollen  lids,  very  abundant  dis 
charge  of  pus,  or  a  dry  and  burning  state  of  the  con 
junctiva  and  lids ;  excruciating  pains  in  the  eyes  and 
head  ;  chemosis  ;  great  intolerance  to  light ;  hot  skin  ; 
nausea ;  thirst ;  and  other  febrile  symptoms  ;  it  be 
comes  us  to  exercise  the  utmost  vigilance  in  our  re 
medial  measures,  in  order  to  save  the  eyes  from  ulcer- 
ation  and  sloughing.  Farther  on  we  shall  detail  a 
method  of  treatment  which  will  generally  be  found 
successful,  even  in  the  most  severe  cases.  Nothing, 
however,  but  the  strictest  attention  to  everv  minute 


592  AFFECTIONS    OF    THE    EYE 

symptom  of  the  case,  and  a  constant  watch  over 
medicinal  effects,  will  ensure  success. 

The  cause  of  this  affection  is  unquestionably  the  ap 
plication  to  the  eyes  of  gonorrhoea!  matter,  and  not,  as 
some  suppose,  a  metastasis  of  the  disease  to  the  eyes. 

Another  variety  of  purulent  ophthalmia  to  which  it 
is  proper  to  allude,  is  that  which  occurs  in  infants 
shortly  after  birth.  This  disease  is  supposed  to  arise 
from  the  contact  of  the  vaginal  secretion  of  the  mat 
ter  with  the  eyes  of  the  child  during  birth.  The 
symptoms  generally  first  make  their  appearance  in 
about  two  weeks  after  birth,  but  they  may  occur  be 
fore  or  several  weeks  after  this  period.  The  symp 
toms  are  similar  to  those  of  purulent  ophthalmia,  but, 
for  the  most  part,  the  inflammation  is  less  intense,  and 
there  is  much  less  danger  of  the  speedy  supervention 
of  ulcers  of  the  cornea.  It  is  quite  true  that  ulcera- 
tion  and  sloughing  ultimately  occur  in  these  cases  ; 
but  a  longer  time  is  afforded  for  our  remedial  efforts  to 
take  effect,  and  of  course  the  prospect  of  cure  thus  en 
hanced. 

SECTION  VI. 

STRUMOUS,    OR    SCROFULOUS    OPHTHALMIA. 

Diagnosis. — Scrofulous  ophthalmia  presents  several 
symptoms  which  are  quite  characteristic,  and  by  the 
aid  of  which  we  may  always  form  a  ready  and  accurate 
diagnosis.  The  disease  occurs  in  subjects  of  a  scrofu 
lous  habit,  and  is  accompanied  with  the  general  signs 
peculiar  to  struma,  in  addition  to  the  local  symptoms. 
Indeed,  these  general  marks  will  often  aid  materially 
in  forming  our  opinion,  particularly  in  slight  cases. 
The  light  and  clear  complexion,  blonde  hair,  blue 
eyes,  tendency  to  glandular  swellings  of  the  neck,  the 
tumid  upper  lip,  eruptions  during  childhood  behind 
the  ears  and  upon  the  head,  sensitiveness  to  cold,  dis 
position  to  cough  after  colds,  frequent  pains  and  dis 
charges  from  the  ears,  indicate  the  strumous  dyscra- 
sia,  which  often  determine  and  develop  inflammations 
of  the  scrofulous  kind. 

The  peculiar  symptoms  which  distinguish  this  in 
flammation  are,  the  almost  absolute  intolerance  to 


AND    ITS    APPENDAGES.  593 

light ;  the  violent  spasmodic  closure  of  the  lids  on  the 
slightest  exposure  of  the  eyes  to  it,  and  the  strumous 
eruptions  which  generally  make  their  appearance  in 
the  neighbourhood  of  the  eyes.  The  light  is  com 
monly  so  painful,  and  the  dread  of  exposure  to  it  is  so 
great,  that  it  is  exceedingly  difficult  to  make  a 
thorough  examination  in  children,  and,  as  a  general 
rule,  it  is  better  to  trust  to  the  voluntary  efforts  of  the 
patient,  in  a  moderate  light,  rather  than  resort  to 
much  violence  in  attempting  to  force  open  the  eyes. 
Usually,  by  obtaining  the  confidence  of  the  patient, 
we  can  persuade  such  a  display  of  the  globes  as  will 
sufficiently  satisfy  us  in  regard  to  the  case.  The 
vessels  of  the  conjunctiva  are  generally  much  inject 
ed  ;  there  is  a  considerable  discharge  of  purulent 
matter ;  the  balls  are  stiff  and  painful  ;  the  lids 
swollen  :  vision  impaired  by  the  inflammation,  or  by 
ulcers  on  the  cornea  ;  one  or  more  ulcers  form  on  the 
conjunctiva  covering  the  cornea  ;  and,  if  the  symp 
toms  continue  to  increase,  the  sight  is  finally  de 
stroyed. 

The  disease  varies  much  in  its  progress  ;  is  some 
times  attended  with  but  little  redness  of  the  conjunc 
tiva,  but  slight  pains  in  the  globes,  and  but  a  mod 
erate  secretion  of  pus  ;  at  other  times,  during  the 
formation  of  a.n  ulcer,  all  these  symptoms  increase  in 
intensity,  until  the  case  nearly  resembles  one  of  acute 
purulent  ophthalmia.  It  is  of  far  more  common  oc 
currence  in  children  than  in  adults. 

Causes. — The  constitutional  cause,  as  we  have  seen, 
is  a  strumous  dyscrasia.  The  local,  or  exciting 
causes  are,  atmospheric  vicissitudes  ;  undue  exposure 
to  cold,  light,  dust,  smoke,  and  irritating  vapours  ;  ne 
glect  of  cleanliness. 

Prognosis. — Severe  purulent  ophthalmia  under  the 
most  favourable  circumstances,  for  the  application  of 
remedies,  is  highly  dangerous.  The  chief  peril 
against  which  we  have  to  guard,  is  ulceration  of  the 
cornea.  Before  this  has  taken  place,  and  especially  if 
the  cornea  appears  bright,  we  may  entertain  hopes  of 
a  favourable  termination  of  the  case  ;  but  if  these 
opaque  specks  form  while  the  inflammation  retains  its 
intensity,  we  must  be  prepared  for  a  partial  or  total 


594  AFFECTIONS    OF    THE    EYE 

loss  of  vision.  Of  the  different  kinds  of  ophthalmia, 
the  gonorrhoeal  is  unquestionably  the  most  rapid  in  its 
progress,  and  dangerous  in  its  character.  Here,  no 
thing  but  the  most  consummate  judgment  and  cool 
ness,  with  constant  attention,  can  avert  serious  conse 
quences.  The  other  varieties  of  the  malady  are  not 
quite  so  rapid  and  destructive,  but  they  demand  the 
most  skilful  and  energetic  efforts  to  ward  off  injuri 
ous  results. 

As  a  general  rule,  if  we  are  called  during  the 
early  stages  of  the  complaint,  and  exhibit  the  ap 
propriate  specifics  judiciously  and  boldly,  little  diffi 
culty  will  be  experienced  in  inducing  a  speedy  and 
happy  issue  to  either  of  the  varieties ;  unfortunately, 
however,  the  physician  is  rarely  called  until  the  dis 
ease  is  so  far  advanced  that  ulceration  cannot  be  pre 
vented.  It  is  evident,  then,  that  the  prognosis  will  de 
pend  upon  the  intensity  of  the  disease,  the  complica 
tions  which  have  occurred,  the  time  it  has  existed, 
the  constitution  of  the  patient,  and  the  remote  and  ex 
citing  causes. 

Therapeutics. — The  only  local  application  which  can 
be  advantageously  used  during  the  acute  stage  of  pu 
rulent  ophthalmia,  is  pure  water,  either  cold  or  tepid. 
This  may  be  employed  as  a  lotion  to  the  parts,  during 
the  course  of  the  acute  symptoms,  as  the  judgment  of 
the  adviser  shall  dictate.  When  the  chronic  stage 
has  set  in,  recourse  may  occasionally  be  had  to  stimu 
lating  collyria,  like  vinum  opii,  solutions  of  sulph., 
zinc,  nitr.  argenti,  sulph.,  cuprum,  acetat.,  plumbi,  and 
aconite  ;  but  in  regard  to  these  applications,  the  same 
rules  apply  with  full  force  here,  that  we  have  pre 
sented  under  the  head  of  simple  acute  ophthalmia, 
when  alluding  to  the  use  of  collyria. 

The  following  remedies  will  cover  all  of  the  symp 
toms  which  obtain  in  the  different  varieties  of  puru 
lent  ophthalmia  :  arsenicum,  belladonna,  sulphur,  rhus 
toxicodendron,  calcarea  carbonica,  aconite,  mercurius 
sol.,  graphite,  phosphorus,  spigelia,  digitalis,  acid  nitr. , 
hepar  sulphur.,  causticum. 

Arsenicum  will  prove  curative  in  purulent  ophthal 
mia,  with  much  vascular  congestion  of  the  conjunc 
tiva  :  swelling  of  the  lids ;  nightly  agglutination ; 


AND    ITS    APPENDAGES.  595 

photophobia ;  pressure  and  burning  pains  in  the  eye 
balls,  aggravated  by  moving  the  eyes  :  nebulous  spots 
and  ulcers  on  the  cornea. 

Belladonna  is  an  admirable  remedy  in  scrofulous  in 
flammation  of  the  eyes,  with  very  great  intolerance  to 
light ;  a  constant  inclination  to  remain  in  the  dark,  or 
to  plunge  the  eyes  into  a  pillow  or  some  other  soft 
article  ;  purulent  discharge  ;  great  swelling  of  the 
lids ;  spasmodic  closure  of  the  lids  on  exposure  to 
light;  chemosis ;  tearing,  throbbing,  smarting,  or 
stitching  pains  in  the  eyes  ;  roaring  in  the  ears  ;  hot, 
dry  skin  ;  thirst ;  nightly  agglutination  ;  throbbing  of 
the  carotid  and  temporal  .arteries  ;  pains  in  the  tem 
ples  and  head;  ulcers  on  the  cornea;  dimness  of 
vision.  We  have  cured  several  cases  of  purulent 
ophthalmia  of  infants,  characterized  by  great  intole 
rance  to  light,  intense  inflammation,  throbbing  of  the 
carotid  and  temporal  arteries,  flushed  cheeks,  hot  skin, 
and  other  indications  of  inordinate  vascular  excite 
ment,  with  belladonna,  succeeded  by  mercurius.  We 
deem  belladonna  one  of  our  most  valuable  medicines 
in  nearly  all  of  the  acute  inflammations  of  the 
eye.  The  effects  arising  from  the  application  of  a 
small  quantity  of  the  extract  to  the  eyebrows  or  tem 
ples,  are  sufficient  to  demonstrate  its  marked  specific 
action  upon  the  structures  of  the  eye.  We  have  found 
it  eminently  serviceable  in  ophthalmia  neonatorum, 
and  in  acute  ophthalmia. 

Sulphur  is  an  invaluable  remedy  in  several  kinds  of 
purulent  ophthalmia.  It  is  adapted  to  the  chronic 
forms,  with  atonic  distention  of  the  conjunctival 
vessels ;  swollen  and  oedematous  condition  of  the 
lids,  with  purulent  discharge  ;  suppurating  ulcers  on 
the  cornea  ;  sensation  of  itching,  burning,  and  heat  in 
the  eyes  and  lids ;  troublesome  agglutination  in  the 
morning ;  diminished  power  of  motion  of  the  upper 
lids ;  pustules  of  the  cornea ;  sensitiveness  to  the 
light  of  the  sun  ;  swollen  upper  lip  ;  eruptions  behind 
the  ears,  and  on  the  scalp  and  face  ;  pressure  and 
burning  pain  in  the  eyes  ;  impaired  vision.  Sulphur 
is  one  of  those  remedies  \vhich  will  be  required 
more  or  less  frequently  in  all  varieties  of  ophthal 
mia,  not  only  to  combat  those  local  symptoms  which 


596  AFFECTIONS    OF    THE    EYE 

especially  correspond  with  it,  but  to  correct  mor 
bid  conditions  of  a  more  general  and  latent  cha 
racter.  Sulphur  may  occasionally  be  used  with  de 
cided  advantage  in  alternation  with  remedies  which 
appear  to  cover  all  of  the  manifest  symptoms,  but 
•which  do  not  produce  prompt  impressions  when  given 
singly. 

Rhus  tox.  is  useful  in  rheumatic,  scrofulous,  and  ca- 
tarrhal  ophthalmia,  with  much  inflammation  and  swell 
ing  of  the  lids  ;  redness  of  the  balls  of  the  eyes ;  profuse 
secretion  of  mucus  or  pus  from  the  eyes  and  lids  ; 
osdematous  swelling  of  the  lids  and  the  parts  surround 
ing  the  eyes  ;  morning  agglutination,  with  increased 
redness  of  the  eyes  ;  pain  on  turning  the  balls  ;  lach- 
rymation  ;  photophobia. 

Dr.  Dudgeon  considers  rhus  toxicodendron  one  of 
the  most  important  remedies  in  catarrha],  erysipela- 
tous,  scrofulous,  and  exanthematic  ophthalmia.  Many 
allopathic  physicians  commend  the  tincture  of  rhus  in 
scrofulous  ophthalmia.  We  can  bear  witness  to  the 
value  of  this  medicine  in  scrofulous  ophthalmia,  and 
in  chronic  ophthalmia  which  is  kept  up  by  a  dyscrasia 
of  an  erysipelatous  character. 

Calcarea  carbonica  has  been  successfully  employed 
in  every  variety  of  purulent  conjunctival  inflammation. 
Its  chief  indications  are,  inflammation,  redness,  and  pu 
rulent  secretion  from  the  eyeballs  ;  swelling  and  red 
ness  of  the  eyelids  ;  nightly,  and  sometimes  daily, 
agglutination  of  the  lids  ;  great  intolerance  to  light; 
nebulous  specks  and  ulcers  on  the  cornea  ;  inclination 
to  keep  the  eyes  in  darkness ;  scrofulous  eruptions 
upon  the  face  and  scalp  ;  glandular  swellings  of  the 
neck  ;  swelling  of  the  upper  lips  and  nostrils  ;  pus 
tules  on  the  cornea  ;  pressing  or  aching  pains  in  the 
eyes  ;  corrosive  inflammation  in  the  edges  of  the  lids  ; 
acrid  lachrymation  ;  general  appearance  indicative  of 
the  scrofulous  dyscrasia.  Dr.  Dudgeon  expresses  the 
opinion  that  calcarea  "  is  one  of  our  most  impor 
tant  ophthalmic  medicines,  and  is  surpassed  by 
none  in  its  applicability  to  the  generality  of  cases 
of  scrofulous  inflammation,  whether  of  the  eye  it 
self,  or  its  lids ;  and  is  indispensable  where  there 


AXD    ITS    APPENDAGES.  597 

is  marked  scrhfuloiis  diathesis,  indicated  by  swell 
ings  of  the  glands,"  &c. 

Aconite  may  often  precede  other  remedies  in  every 
variety  of  purulent  ophthalmia,  when  the  inflammation 
runs  high,  and  gives  rise  to  febrile  symptoms.  Intense 
redness  and  swelling  of  the  affected  parts  ;  acute 
pains  ;  accelerated  circulation  ;  violent  photophobia  ; 
headache  ;  hot  and  dry  skin ;  Thirst ;  flushed  cheeks  ; 
throbbing  of  the  arteries  about  the  neck,  head  and  face ; 
loss  of  appetite  ;  and  perverted  vision,  point  to  the  em 
ployment  of  aconite.  In  some  instances  it  may  be  al 
ternated  with  belladonna  to  advantage. 

Mercurius  sol.  has  proved  successful  in  my  hands 
in  gonorrhceal,  scrofulous,  and  infantile  ophthalmia  ; 
the  remedy  having  been  preceded  by  aconite.  The 
symptoms  were,  violent  inflammation,  and  redness  of 
the  eyes  ;  great  intolerance  to  light  ;  profuse  acrid  or 
purulent  secretion  from  the  balls  and  lids  ;  spasmodic 
closure  of  the  lids  ;  heat  in  the  eyes  ;  cutting  and 
burning  pains  in  the  parts  ;  ulcers  on  the  cornea  ;  cor 
nea  dim  and  misty  ;  sight  impaired  ;  frequent  agglu 
tination  of  the  lids  ;  gummy  and  scurfy  matter  on  the 
edges  of  the  lids. 

Graphite  is  one  of  our  best  remedies  in  scrofulous 
ophthalmia,  with  excessive  intolerance  to  light ;  chronic 
congestion  of  the  conjunctiva  ;  purulent  secretion  from 
the  balls  and  lids  ;  frequent  agglutination  of  the  lids  ; 
ulcers  on  the  cornea  ;  porrigo  in  the  face  ;  eyelids 
much  inflamed,  red,  and  painful  ;  inability  to  open 
the  eyes  before  a  strong  light ;  constant  desire  to  keep 
the  eyes  covered  ;  symptoms  worse  by  day-light  than 
by  candle-light ;  general  appearance  indicative  of  a 
scrofulous  diathesis. 

Phosphorus  is  sometimes  useful  in  obstinate  and  pro 
tracted  cases  of  atonic  ophthalmias,  \vhich  have  re 
sisted  the  ordinary  remedies.  There  is  generally  in 
flammation  and  moderate  redness  of  the  eyes  ;  con 
siderable  secretion  of  viscid  mucus;  sensitiveness  of 
the  eyes  to  light  ;  heat,  burning  and  itching  of  the 
eyes ;  lachrymation  during  the  day ;  frequent  and  sud 
den  attacks  of  blindness  during  the  day  ;  floats  before 
the  eyes  ;  weakness  and  indistinctness  of  vision. 

Spigelia  is  advised  in  purulent  inflammation,  prin- 


598  AFFECTIONS    OF    THE    EYE 

cipally  affecting  the  eyelids,  with  sharp  pains  in  the 
lids  ;  pressure  and  pain  in  the  eyeballs  during  motion ; 
distention  and  paralysis  of  the  upper  lids  ;  painful  ul- 
ceration  of  the  edges  of  the  lids  ;  dimness  of  the  cor 
nea  ;  general  loss  of  power  over  the  eyes.  Rummel 
speaks  highly  of  spigelia  in  rheumatic  and  gouty  in 
flammations  attacking  the  cornea. 

Digitalis  is  recommended  in  conjunctival  ophthal- 
mise  arising  from  colds,  with  acute  inflammation,  red 
ness,  sharp  stitches,  photophobia,  secretion  of  puru 
lent  matter,  and  obstruction  and  dryness  of  the  nose. 

Nitric  acid  and  hepar  sulph.  are  the  best  specifics 
for  the  removal  of  mercurial  ophthalmia,  following  the 
abuse  of  this  drug  in  syphilis  and  other  diseases.  The 
symptoms  are,  inflammation,  swelling  and  redness  of 
the  conjunctiva  and  lids  ;  secretion  of  viscid  mucus  or 
pus  ;  burning  and  smarting  sensation  in  the  eyes  ; 
photophobia,  dark  and  unhealthy  ulcers  on  the  cornea  ; 
paralysis  of  the  upper  eyelids  ;  tears  easily  excited  ; 
nightly  agglutination  ;  muscae  volitantes  and  sparks 
before  the  eyes  ;  difficulty  and  pain  in  moving  the 
eyes  ;  pains  in  the  bones  and  soft  parts  of  the  forehead 
and  face. 

We  have  employed  chininum  sulph.,  at  the  first  tri- 
turation,  in  several  obstinate  cases  of  strumous  and 
chronic  ophthalmia,  with  entire  success.  When  the 
malady  assumes  an  intermittent  character,  it  will  gen 
erally  prove  promptly  curative. 

Lobethal  has  employed  euphrasia  with  much  suc 
cess  in  rheumatic,  strumous,  and  catarrhal  ophthalmia, 
where  there  was  "considerable  mucous  secretion  in  the 
inflamed  organ  ;  as  also  in  blennorrhoeas  of  the  eyes, 
in  all  which  cases  I  employ  euphrasia  at  once,  inter 
nally  and  externally  ;  in  the  former  case,  one  drop  of 
the  pure  tincture  ;  in  the  latter,  as  a  collyrium,  from 
two  to  five  drops  in  four  ounces  of  water." 

Lycopodium  is  well  adapted  to  scrofulous  or  catarrhal 
ophthalmia,  and  in  obstinate  cases  of  ophthalmia 
neonatorum.  Hahnemann  mentions  "  nocturnal  ag 
glutination,  and  lachrymation  by  day/'  as  prominent 
indications  for  the  use  of  lycopodium. 

We  have  employed  aurum  with  excellent  effects  in 
several  cases  of  mercurial  and  syphilitic  ophthalmia. 


AND    ITS    APPENDAGES.  599 

Some  authors  recommend  it  highly  in  scrofulous  oph 
thalmia. 

Other  remedies  are,  causficum,  sepia,  silicea,  staphy- 
sagria,  china,  and  chamomilla. 

Administration. — In  acute  cases,  we  prefer  the  first, 
second,  and  third  attenuations,  and  in  the  chronic  stage, 
the  first  attenuation.  The  remedy  should  be  repeated 
in  the  more  violent  forms  of  the  complaint,  every  half 
hour,  until  we  are  satisfied  with  the  impression  ;  but 
in  chronic  inflammations,  a  repetition  once  in  twelve 
or  twenty-four  hours  will  suffice.  During  the  treat 
ment  we  should  never  neglect  the  external  use  of 
pure  water,  or  milk  and  water,  either  cold  or  tepid. 

SECTION  VII. 

GRANULATED     LIDS. 

Diagnosis. — Fleshy  elevations  sometimes  occur  on 
that  portion  of  the  conjunctiva  which  lines  the  eye 
lids,  resembling  in  all  respects  granulations,  and  by 
their  irritating  effects  upon  the  ball  of  the  eye,  give 
rise  to  troublesome  inflammation,  ulceration,  and  now 
and  then  to  loss  of  sight.  This  affection  has  more 
frequently  baffled  the  surgeons  of  the  old  school,  than 
any  other  pertaining  to  the  eye.  Venesection,  leech 
ing,  cupping,  blistering,  moxas,  cathartics,  alteratives, 
stimulating  collyria,  and  caustic  applications,  have  all 
been  found  entirely  inefficient  in  its  treatment,  and 
the  patients  are  generally  doomed  to  a  wretched  ex 
istence,  one  or  more  years,  until  disorganization  of  the 
eyes,  by  ulceration,  leaves  them  in  perpetual  darkness. 
By  homoeopathy,  however,  a  new  and  healthy  action 
can  be  created  in  the  affected  structure,  which  shall 
overcome  and  supersede  the  morbid  action. 

These  morbid  granulations  usually  arise  from  an 
acute  or  sub-acute  inflammaiion  of  the  conjunctiva 
occurring  in  individuals  whose  constitutions  have  be 
come  impaired  and  tainted  by  protracted  syphilitic, 
gonorrhoeal,  psoric,  or  scrofulous  complaints.  The 
granulations  are  rough  and  uneven,  secrete  an  abun 
dance  of  pus,  which  serves  to  irritate  and  weaken  the 
eyes,  and  on  every  motion  of  the  lids,  operate  on  the 
balls  as  foreign  substances,  thus  keeping  up  a  per- 


600  AFFECTIONS    OF    THE    EYE 

petual  inflammation,  and  sooner  or  later  leading  to 
ulceration  of  the  cornea.  The  disease  is  for  the  most 
part  confined  to  the  upper  lids,  although  we  have  seen, 
in  some  instances,  the  conjunctiva  of  the  lower  lids 
rough  and  granulated. 

Occasionally  we  may  detect  the  true  character  of 
the  complaint  by  the  thickness  of  the  lids,  and  their 
roughness  and  unevenness  to  the  touch  ;  but  the  only 
certain  method  of  investigation  consists  in  turning 
over  the  lids,  and  thus  exposing  the  palpebral  conjunc 
tiva  to  the  sight. 

This  disease  very  often  proceeds  to  a  fatal  disor 
ganization  of  the  eye,  without  a  true  knowledge  on 
the  part  of  the  physician,  respecting  the  nature  of  the 
case.  It  is  usually  mistaken  for  one  of  the  varieties 
of  purulent  ophthalmia. 

Therapeutics. — The  remedies  in  this  disease  are 
both  local  and  constitutional.  The  only  local  specific 
is  the  sulphate,  of  copper  in  substance,  a  small  piece 
of  which  is  to  be  smoothly  polished,  and  rubbed 
lightly  over  the  granulations  once  or  twice  a  day, 
following  each  application  with  a  camel's-hair  brush 
filled  with  pure  water,  A  persevering  use  of  this 
substance  will,  as  we  know  from  much  experience  in 
these  cases,  cure  the  most  inveterate  forms  of  the 
complaint. 

In  conjunction  with  the  above  means,  we  may  em 
ploy  one  of  the  following  medicines :  sulphur,  calcarea 
carbonica,  hepar  sulph.,  iodine,  graphite,  and  acid  nit., 
as  internal  remedies. 

In  selecting  our  internal  remedy,  regard  must  be 
had  to  the  cause,  as  well  as  the  symptoms  of  the  dis 
ease.  We  advise  the  first  attenuations,  and  the  dose 
to  be  repeated  once  in  twelve  or  twenty-four  hours  as 
long  as  necessary. 

SECTION  VIII. 

OPACITY    OF    THE    CORNEA. 

Diagnosis. — Opacities  or  specks  upon  the  cornea 
vary  much  in  size  and  appearance.  Various  appel 
lations  have  been  given  to  these  different  opacities, 
as  nebula,  leucoma,  albugo,  &,c.,  depending  upon  the 


AND    ITS    APPENDAGES.  601 

nature  of  the  cause,  and  the  particular  tissue  affected. 
The  opacity  may  consist  of  slight  misty  or  opaque 
spots,  diffused  over  a  part  or  even  the  whole  of  the 
cornea,  of  a  light  colour,  such  as  are  caused  by  a  per 
verted  secretion  of  the  inner  lamina,  and  termed 
nebula;  or  of  small  and  circumscribed  spots,  of  a 
pearl  colour,  and  entirely  opaque,  caused  by  a  kind  of 
false  membrane  under  the  conjunctiva,  and  termed 
leucoma ;  or  of  cicatrixes  resulting  from  the  healing 
of  ulcers  and  wounds  of  the  cornea,  and  termed  al 
bugo. 

When  the  disease  consists  of  a  simple  diffused 
nebulous  opacity,  we  can  distinguish  through  it  the 
pupil  and  iris,  and  the  rays  of  light  pass  to  the  retina 
so  as  to  give  rise  to  imperfect  vision ;  but  the  other 
kinds  of  opacity  do  not  permit  the  passage  of  lumi 
nous  rays,  and,  consequently,  when  situated  in  front 
of  the  pupil,  destroy  or  seriously  impair  vision. 

The  two  first  varieties  are  caused  by  purulent  oph 
thalmia  and  granulated  lids,  and  are  results  most  to 
be  dreaded,  especially  in  constitutions  tainted  with 
scrofula,  syphilis,  psora,  or  mercury. 

Therapeutics. — The  best  local  stimulus  is  a  collyrium 
composed  of  one  grain  of  sulphate  of  zinc  to  four 
ounces  of  water.  A  few  drops  of  this  may  be  put 
into  the  affected  eye  from  two  to  four  times  in  twen 
ty-four  hours  until  the  opacity  begins  to  disappear, 
when  we  should  omit  it  so  long  as  amendment  con 
tinues. 

The  internal  remedies*  most  to  be  relied  on  are, 
calcarea  carbonica,  iodine,  mercurius,  sulphur,  sepia, 
arnica,  hepar  sulphuris,  acid  nit.,  aurum  muriaticum. 

Attenuations  and  repetitions  the  same  as  in  chronic 
ophthalmia. 

SECTION  IX. 

AFFECTIONS  OF  THE  DEEPER  SEATED  STRUCTURES  OF  THE 

EYE. 

INFLAMMATION    OF    THE    CORNEA. 

Diagnosis. — Inflammation  of  the  cornea  may  exist 
as  an  independent  affection,  or  it  may  occur  during 
the  progress  of  iritis,  and  other  acute  derangements 

26 


602  AFFECTIONS    OF    THE    EYE 

of  the  internal  textures  of  the  eye.  Soon  after  the 
inflammation  sets  in,  a  number  of  the  serous  vessels 
are  observed  to  carry  red  blood  ;  the  cornea  loses  its 
brilliancy ;  the  eyes  become  sensitive  to  light ;  a  pro 
fuse  secretion  of  tears  is  induced  from  exposure  to 
cold  air,  light,  dust,  and  smoke  ;  tension  and  pains 
are  experienced  in  the  eye  ;  yellow  spots,  composed  of 
pus,  are  observed  between  the  lamellae  of  the  cornea 
by  looking  obliquely  through  the  eye  ;  these  abscesses, 
if  the  disease  continues,  eventually  burst  internally, 
and  discharge  their  contents  into  the  anterior  cham 
ber,  or  externally,  and  form  those  troublesome  ulcers 
of  the  cornea  which  so  often  endanger  sight.  When 
these  ulcers  are  small,  and  confined  to  the  anterior 
portion  of  the  cornea,  they  may  often  be  cured  with 
out  material  injury  to  the  eye ;  but  when  the  ulce- 
ration  pervades  the  whole  lamellated  structure  of  the 
cornea,  it  is  not  uncommon  for  the  aqueous  humour  to 
escape  through  the  opening,  and  even  the  iris  itself 
to  protrude. 

SECTION    X. 

IRITIS. 

Diagnosis. — This  peculiar  affection  of  the  eye  is 
by  no  means  easy  of  detection,  on  account  of  the  situ 
ation  of  the  iris,  and  the  small  number  of  external 
symptoms  which  characterize  the  complaint.  Inflam 
mation  of  this  texture  is,  however,  more  productive  of 
constitutional  or  febrile  symptoms  than  affections  of 
the  external  tunics.  This  may  in  part  be  owing  to 
the  loose  attachment  of  the  conjunctiva  to  the  eye, 
and  the  more  ample  scope  for  effusions  into  the  sub 
jacent  cellular  tissue. 

Iritis  commences  with  a  dull,  pressing,  heavy  and 
deep-seated  pain  in  the  orbit  ;  contracted  pupil  ; 
change  of  the  natural  colour  of  the  iris  to  a  dark, 
greenish,  or  reddish  colour ;  a  moderate  rose-coloured 
blush  of  the  conjunctiva  ;  diminished  power  of  vision, 
and  considerable  sensibility  to  light. 

As  the  disease  advances,  the  pains  become  acute, 
and  extend  from  the  eye  into  the  temples  and  to  the 
top  of  the  head  ;  the  contraction  is  more  strongly 


AND    ITS    APPENDAGES.  603 

pronounced  ;  sparks  and  luminous  flashes  pass  through 
and  before  the  eyes  ;  the  nervous  system  is  excited ; 
the  pulse  accelerated  ;  the  skin  hot  and  dry  ;  the  in 
testinal  and  urinary  secretions  are  partially  sup 
pressed,  and  there  are  other  indications  of  constitu 
tional  disturbance. 

After  these  severe  symptoms  have  continued  some 
time,  the  iris  presents  an  irregular,  angular,  and  thick 
ened  appearance,  and  is  covered  with  specks  of  yellow 
lymph.  Small  abscesses  now  form  on  the  iris,  which 
ultimately  burst  into  the  anterior  chamber,  which  is 
afterwards  usually  absorbed.  If  extensive  adhesions 
have  formed  between  the  iris  and  the  capsule  of  the 
lens,  or  if  the  more  deep-seated  parts  have  become 
involved  in  the  disease,  an  almost  total  loss  of  sight  is 
the  common  result. 

In  some  instances,  the  inflammation  extends  from 
the  iris  to  the  retina,  the  choroides,  the  cornea,  and 
finally  involves  the  whole  internal  structure  of  the 
eye,  when  the  malady  will  present  symptoms  charac 
teristic  of  the  inflammation  of  these  different  struc 
tures.  In  cases  of  this  description,  the  symptoms  are 
of  the  most  violent  character,  the  pains  are  exceed 
ingly  acute  and  painfully  throbbing,  there  is  a  very 
rapid  contraction  of  the  pupil,  the  sight  is  speedily 
extinguished,  the  constitutional  signs  are  very  urgent, 
and  the  patient  is  always  in  imminent  danger  of  rapid 
and  permanent  loss  of  vision. 

Causes. — The  most  common  cause  of  iritis  is  the 
abuse  of  mercury.  Syphilis  has  been  often  assigned 
as  a  cause  of  it,  but,  we  believe,  without  just  reason. 
It  has  often  been  observed  during  the  treatment  of 
syphilis  by  mercury,  but,  we  think,  never  in  syphilitic 
diseases  where  mercury  has  not  been  employed. 
Other  causes  are,  mechanical  injuries,  rheumatism, 
gout,  excessive  use  of  the  eyes  over  minute  objects. 

Therapeutics. — The  most  appropriate  remedies  are, 
hepar  sulphur.,  acid  nit.,  muriat.  aurum,  cocculus,calca- 
rca  carbonica,  nux  vomica,  belladonna,  conium,  lycopo- 
dium,  staphysagria,  arnica,  aconite. 

Hepar  salphuris,  acid  nitric,  and  aarum  muriaticum, 
are  curative  in  iritis  arising  from  abuse  of  mercury, 
with  aching,  throbbing,  and  tearing  pains  in  the  orbit, 


604  AFFECTIONS    OF    THE    EYE 

sometimes  extending  to  the  top  of  the  head  ;  pains  in 
the  bones  about  the  eyes ;  fiery  sparks  before  the 
eyes  ;  intolerance  to  light ;  contracted  pupil  ;  partial 
or  entire  loss  of  vision  ;  dark  or  greenish  colour  of 
the  iris  ;  spots  of  yellow  lymph,  or  ulcers  on  the  iris  ; 
febrile  disturbance. 

Cocculus,  nux  vomica,  and  belladonna,  are  indicated 
in  arthritic  and  rheumatic  iritis,  accompanied  with 
deep-seated,  lancinating,  tearing,  or  contractive  pains 
in  the  ball,  and  extending  to  the  top  of  the  head ;  in 
voluntary  spasmodic  movements  of  the  globe  :  irre 
gular  contraction  of  the  pupil ;  discoloured  and  puck 
ered  iris  ;  photophobia ;  pains  aggravated  on  moving 
the  eyes,  or  stooping  ;  luminous  specks  or  darkobjpcts 
float  before  the  retina  ;  greatly  impaired  vision  ;  effu 
sion  of  blood  and  matter  into  the  anterior  chamber 
of  the  eye  ;  indications  of  gastric  derangement,  and 
of  general  constitutional  disturbance. 

Calcarea  carbonica,  conium,  lycopodium,  and  staphy- 
sagria,  are  appropriate  in  iritic  inflammations  con 
nected  with  a  scrofulous  diathesis.  These  remedies 
cover  greenish  or  yellowish  colour  of  the  iris ;  pupil 
much  contracted  and  distorted  ;  ulcers  which  have 
opened  internally  or  externally ;  outward  distention 
of  the  iris  ;  adhesions  of  the  iris  to  the  capsule  of  the 
lens  ;  moderate  participation  of  all  the  structures  of 
the  eye  in  the  morbid  action  ;  photophobia  ;  vision 
destroyed  or  much  impaired  ;  difficulty  in  distinguish 
ing  the  iris  from  effusion  of  lymph  and  pus  into  the 
anterior  chamber  of  the  eye  ;  great  general  irritabil 
ity  ;  aching,  throbbing,  lancinating,  or  pressing  pains 
in  the  eye  ;  rapid  and  irritable  pulse  ;  restlessness  ; 
hot  skin ;  loss  of  appetite  ;  mental  and  physical  pros 
tration. 

Arnica  is  necessary  when  the  disease  can  be  traced 
to  a  wound,  or  to  any  other  mechanical  injury  of  the 
eye.  It  may  also  be  properly  employed  in  cases  which 
proceed  from  sudden  exposure  of  the  eyes  to  an  in 
tense  and  glaring  light. 

Aconite  will  often  be  required,  either  alone,  or  in 
alternation  with  one  of  the  other  remedies,  to  control 
undue  febrile  excitement,  and  to  remove  the  violent 
congestion  which  now  and  then  occurs  in  iritis. 


AND    ITS    APPENDAGES.  605 

Administration. — The  remedies  may  be  employed 
at  the  first,  second,  and  third  attenuations,  depending 
upon  the  age  and  susceptibility  of  the  patient,  and  the 
violence  of  the  inflammation.  The  dose  should  be 
repeated  in  acute  cases  every  two  hours,  until  we  are 
certain  of  a  medicinal  impression  upon  the  diseased 
texture.  In  less  urgent  cases,  a  repetition  will  suffice 
once  or  twice  in  twenty-four  hours. 

SECTION    XI. 

AMAUROSIS. 

Diagnosis. — The  partial  or  total  loss  of  sight  which 
particularly  characterizes  this  disease,  is  principally 
dependent  upon  a  diseased  condition  of  the  optic  nerve 
and  retina,  although  other  structures  occasionally  par 
ticipate  in  the  disease.  Amaurosis  occurs  at  all  ages, 
and  in  both  sexes,  but  is  most  common  at  the  period 
of  the  cessation  of  the  menses  in  females,  and  at  the 
age  of  forty  or  fifty  years  in  males.  The  chief  cir 
cumstances  which  predispose  to  it  are,  a  plethoric 
and  sanguine  temperament,  hereditary  disposition, 
tendency  to  sanguineous  congestions  to  the  head  and 
eyes,  and  an  impaired  constitution  from  abuse  of  drugs, 
stimulating  drinks,  and  excesses  in  venery. 

Physicians  of  the  old  school  are  much  divided  re 
specting  the  nature  and  treatment  of  amaurosis.  some 
supposing  it  to  be  a  debility  requiring  tonics  and  stim 
ulants,  while  others  describe  it  as  an  inflammatory 
affection,  demanding  an  antiphlogistic  course  of  treat 
ment.  In  view  of  these  discordant  opinions,  and  em- 
pyrical  methods,  it  is  not  surprising  that  so  few  amau- 
rotic  patients  are  cured  by  allopathy. 

Amaurosis  may  be  imperfect  or  perfect.  In  the 
former  there  is  a  partial,  and  in  the  latter  a  total  loss 
of  sight.  In  the  first,  the  patient  sees  as  through  a 
gauze,  or  but  half  of  the  object,  or  double,  or  only 
when  the  eye  is  in  a  particular  position  with  respect  to 
the  object ;  while  in  the  last,  the  patient  cannot  dis 
tinguish  day  from  night. 

The  signs  of  the  approach  of  the  disease  are,  pain 
in  the  forehead  and  temples,  diminishing  with  the  ad 
vance  of  the  amaurosis,  and  ceasing  when  it  has  be- 


606  AFFECTIONS    OF    THE    EYE 

come  complete;  vertigo  ;  weakness  and  cloudiness  of 
vision,  apparent  when  looking  at  distant  or  at  minute 
objects ;  sparks  and  moats,  or  musca3  volitantes,  float 
before  the  eyes,  annoying  the  patient,  and  impairing 
the  sight ;  in  reading  or  writing,  a  stronger  light  than 
usual  is  demanded  ;  a  slight  diminution  in  the  bril 
liancy  of  the  pupil. 

After  these  precursory  symptoms,  the  loss  of  vision 
gradually  becomes  more  complete,  until  after  months 
or  years,  there  remains  a  condition  of  settled  and 
more  or  less  perfect  amaurosis.  In  other  instances, 
the  disease  advances  with  rapidity,  and  terminates  in 
partial  or  total  blindness  in  a  few  days.  But  it  is  not 
an  uncommon  occurrence  for  complete  amaurosis  to 
follow  instantaneously,  leaving  the  victim  in  blindness 
so  profound  that  he  cannot  distinguish  light  from 
darkness.  When  either  of  these  three  conditions  ob 
tains,  there  are  usually  but  few  signs  which  indicate 
the  presence  of  so  serious  an  affection,  the  principal 
being,  a  dilated  and  immovable  pupil,  a  loss  of  con 
tractile  power  in  the  iris,  and  occasionally  slight  stra 
bismus.  But  even  these  signs  are  not  uniformly  pre 
sent,  for  cases  of  complete  amaurosis  are  reported  in 
which  the  pupil  remained  natural,  or  became  preter 
natural  ly  contracted  and  mobile  on  exposure  to  light, 
and  in  which  the  iris  and  all  other  visible  parts  of  the 
organ  were  in  a  normal  condition.  The  colour  of  the 
pupil  in  this  disease  is  ordinarily  jet  black,  with,  per 
haps,  a  very  slight  diminution  of  its  natural  brilliancy, 
but  it  sometimes  presents  a  red,  greenish,  or  white 
and  cloudy  appearance.  Cases  of  this  last  description 
are  often  mistaken  for  incipient  cataract,  and  when 
the  loss  of  sight  is  but  partial,  it  is  not  easy  to  distin 
guish  between  the  two  maladies  ;  but  the  following 
characteristics  will  afford  us  material  assistance  in 
deciding  the  matter.  In  cataract,  the  dense  white  ap 
pearance  is  situated  immediately  behind  the  pupil, 
while  in  amaurosis  the  cloud  is  more  deep-seated.  In 
the  former,  the  flame  of  a  candle  appears  to  be  sur 
rounded  by  a  thin,  white,  diffused  mist  or  cloud, 
"  which  increases  with  the  distance  of  the  light," 
while  in  the  latter,  "  a  halo  or  iris  appears  to  encircle 
or  emanate  from  the  mist,  the  flame  seeming  to  be 
split  when  at  a  distance." — Stephenson. 


AND    ITS    APPENDAGES.  607 

The  shape  of  the  pupil  is  usually  round,  but  some 
what  more  dilated  than  in  the  normal  state,  thus  al 
lowing  a  large  number  of  luminous  rays  to  enter  the 
eye.  In  a  few  cases,  it  loses  its  circular  form,  and 
becomes  angular. 

Amaurosis  is  attributed  by  most  writers  to  a  para 
lytic  condition  of  the  optic  nerve,  retina,  or  to  some 
disease  of  the  thalami  nervorum  opticorum  ;  but  does 
not  the  peculiar  immovable  condition  of  the  pupil  and 
iris,  when  their  natural  stimulus,  the  light,  strikes 
them,  indicate  a  loss  of  sensibility  and  contractility  in 
these  structures  ?  And  does  not  the  partial  loss  of 
voluntary  motion  over  the  globe,  which  sometimes 
occurs  during  the  complaint,  indicate  a  loss  of  tone  in 
the  whole  organ  ? 

We  have  mentioned,  as  one  of  the  precursory  symp 
toms  of  amaurosis,  floats  and  muscae  volitantes  before 
the  eyes.  In  the  imperfect  form  of  the  disease,  these 
appearances  vary  much  in  their  character,  and  are  a 
source  of  great  annoyance  to  the  patient.  Sometimes 
a  single  black  speck  obstructs  the  sight ;  sometimes 
there  is  an  appearance  as  if  a  dark  gauze  or  net-work 
were  before  the  eyes  ;  sometimes  as  if  flies,  small  ob 
jects  of  different  forms,  sparks,  fireballs,  and  various 
coloured  lights,  were  moving  there  in  various  direc 
tions.  The  objects  are  more  troublesome  in  a  strong 
light  than  in  dark  situations,  being  in  the  former  of  a 
black  or  sombre  colour,  and  in  the  latter,  presenting 
themselves  in  the  appearance  of  sudden  flashes  of 
light  or  fire. 

We  are  occasionally  presented  with  the  disease  in 
an  intermittent  form,  and,  in  rare  instances,  as  a  tem 
porary  attendant  of  some  particular  morbid  condition 
of  the  system,  like  pregnancy,  disordered  menstrua 
tion,  hysteria,  worms,  and  the  irritation  of  indigestible 
food. 

In  addition  to  the  symptoms  already  described,  we 
sometimes  observe  in  young  and  plethoric  amaurotics, 
strongly  pronounced  determination  of  blood  to  the 
head  and  eyes,  a  constant  stupifying  headache,  more 
or  less  redness  and  congestion  of  the  eyeballs,  sensi 
tiveness  of  the  eyes  to  light,  a  full  and  hard  pulse,  a 
sense  of  fulness,  tension,  and  pain  in  the  affected  eye. 


608  AFFECTIONS    OF    THE    EYE 

It  is  a  point  worthy  of  note,  that  black  eyes  are  far 
more  subject  to  amaurosis  than  blue  or  gray  eyes. 
Beer  supposes  that  where  one  blue  or  gray  eye  be 
comes  affected  with  it,  at  least  twenty-five  or  thirty 
black  ones  suffer.  No  satisfactory  explanation  has 
ever  been  suggested  for  this  comparative  exemption 
of  blue  and  gray  eyes. 

Causes. — The  causes  of  amaurosis  may  operate 
upon  the  brain  itself,  upon  the  optic  nerve,  or  the  re 
tina.  They  may  be  divided  into  constitutional  and 
local  causes.  In  the  first  class  we  include,  repeated 
and  protracted  determinations  of  blood  to  the  head 
and  eyes,  by  unusual  physical  or  mental  exertion ; 
pregnancy  ;  suppression  of  natural  or  habitual  dis 
charges  ;  violent  vomiting  ;  excessive  indulgence  in 
venery  ;  onanism  ;  unbridled  anger,  grief,  and  other 
passions  ;  abuse  of  stimulants  ;  large  doses  of  opium, 
lead,  belladonna,  hyoscyamus,  stramonium  ;  abuse  of 
bitter  medicines,  as  quassia,  cinchona,  chamomela, 
chicory,  &c. ;  exercise  in  a  hot  sun  ;  general  debility  ; 
derangement  of  the  digestive  organs  ;  the  depressing 
emotions  ;  the  pressure  of  tumours  upon  the  vessels 
of  the  neck  in  such  a  manner  as  to  prevent  the  return 
of  blood  from  the  brain. 

We  include  in  the  second  class,  morbid  growths 
within  the  orbit ;  mechanical  injuries  of  the  eye ; 
sudden  transitions  from  darkness  to  a  brilliant  light : 
lightning  ;  frequent  use  of  optical  instruments,  like 
the  telescope  and  microscope  ;  exostoses  within  the 
cranium  ;  sanguineous  effusion  upon  the  brain  ;  inju 
ries  of  the  head. 

Prognosis. — When  the  disease  is  dependent  on  some 
cause  which  can  be  readily  removed,  if  recent,  and 
the  patient  is  young  and  healthy,  we  may  predict  a 
favourable  termination.  If,  however,  the  cause  has 
been  long  in  operation,  the  Joss  of  sight  has  been  very 
gradual,  the  constitution  is  much  impaired,  and  the 
cause  cannot  be  speedily  removed,  the  prognosis  must 
be  unfavourable.  Amaurosis  depending  on  morbid 
growths  within  the  orbit  or  cranium,  may  be  con 
sidered  incurable  ;  but  when  it  depends  upon  a  slight 
effusion  upon  the  brain,  or  the  pressure  of  a  tumour 
upon  the  jugular  vein  of  the  neck,  we  may  often  effect 


AND    ITS    APPENDAGES.  609 

a  cure  by  causing  the  effused  fluid  to  be  absorbed  or 
removed  by  an  operation,  or  the  extraction  of  the 
offending  tumour.  We  once  cured1  a  case  of  several 
months'  duration,  by  removing  from  the  neck  a  tumour 
of  the  size  of  an  orange,  and  thus  renewing  the  free 
course  of  blood  from  the  head.  The  sight  returned 
almost  immediately  after  the  operation.  The  loss  of 
sight  which  sometimes  accompanies  pregnancy  and 
intermittent  diseases,  often  subsides  spontaneously  on 
the  birth  of  the  infant,  or  the  cure  of  the  disease.  A 
favourable  prognosis  may  commonly  be  entertained 
in  those  recent  cases  which  depend  on  congestion  of 
the  optic  nerve,  retina,  or  thalami  nervorum  optico- 
rum,  arising  from  general  plethora,  suppressed  men 
struation,  or  haemorrhoids.  The  effects  also  of  me 
chanical  injuries,  lacerations,  contusions  and  blows 
upon  the  eye,  may  frequently  be  cured. 

Therapeutics. — The  specifics  for  the  different  forms 
of  amaurosis  are,  belladonna,  nux  vom.,  china,  phos 
phorus,  ruta  grav.,  stramonium,  sulphur,  euphrasia,  ar 
nica,  cannabis,  hyoscyamus. 

Belladonna. — External  indications. — Pupil  dilated 
and  immovable ;  strabismus ;  pupil  black  and  round 
or  angular ;  partial  or  total  loss  of  vision  ;  listless 
expression. 

Physical  sensations. — Power  of  vision  diminished  or 
extinct ;  sensation  of  weight  and  pressure  in  the  eye 
ball  ;  throbbing  or  stupifying  headache  ;  objects  ap 
pear  double,  or  wrong  side  up,  or  half  concealed,  or 
blurred,  or  surrounded  by  a  fog  or  mist ;  dark,  fiery 
and  red  bodies  float  before  the  eyes ;  bright  flashes 
before  the  eyes  ;  the  candle  seems  surrounded  by  a 
halo  of  different  colours,  but  in  which  the  red  pre 
dominates. 

Mental  and  moral  symptoms. — Mood  generally  irri 
table,  but  high  spirits  alternating  \vith  despondency. 

Remarks. — This  remedy  is  called  for  in  amaurotics 
of  full  and  plethoric  habits,  and  where  the  malady 
has  been  caused  by  inflammation  or  congestion  of  the 
optic  nerve,  retina,  or  some  part  of  the  brain. 

Nux  vomica. — External   indications. — Pupils   con 
tracted,  sometimes  dilated  ;  spasmodic  motions  of  the 
eyeball;  photophobia. 
26* 


GJO 


AFFECTIONS    OF    THE    EYE 


Physical  sensations. — Intermittent  obscuration  of 
vision  ;  black  or  gray  moats  before  the  eyes  ;  stupi- 
fying  headache  ;  weakness  of  sight,  worse  in  the  light 
of  day  ;  luminous  vibrations  on  the  side  of  the  eye  ; 
vertigo. 

Mental  and  moral  symptoms. — Disposition  melan 
cholic  and  hypochondriacal. 

Remarks. — Nux  is  applicable  in  amaurotic  com 
plaints  arising  from  excess  of  study  and  abuse  of 
stimulants  and  opium.  It  is  also  indicated  for  tempo 
rary  loss  of  sight,  which  sometimes  accompanies  in 
termittent  diseases. 

China. — External  indications. — Pupils  dilated  and 
insensible,  or  slightly  contracted  ;  a  white  cloud  deep 
within  the  eye  ;  photophobia. 

Physical  sensations. — Indistinct  and  confused  vision ; 
muscae  volitantes  ;  sudden  obscurations  of  sight ;  only 
the  outlines  of  objects  can  be  discerned  ;  general  de 
bility  ;  irritability  ;  morbid  sensitiveness  of  the  whole 
system. 

Mental  and  moral  symptoms. — Disposition  cheerful 
and  languid. 

Remarks. — China  will  apply  when  the  disease  is  of 
a  purely  atonic  character,  and  has  originated  from 
excessive  loss  of  blood  or  pus,  or  from  protracted 
chronic  or  acute  diseases. 

Phosphorus. — External  indications. — Pupils  and  eyes 
natural. 

Physical  sensations. — Sudden  attacks  of  blindness 
during  the  day  ;  distant  objects  appear  to  be  envel- 
loped  in  smoke  or  mist  ;  black  spots  before  the  eyes  ; 
diminished  vision  ;  he  sees  as  through  a  net-work  or 
gauze  ;  sparks  before  the  eyes  in  the  dark  ;  tremulous 
vision ;  luminous  vibrations  before  the  eyes ;  the 
flame  of  a  candle  seems  to  be  surrounded  by  a  green 
halo. 

Mental  and  moral  symptoms. — Spirits  gloomy,  de 
jected,  and  without  any  cheerful  reaction. 

Remarks. — In  amaurosis  consequent  upon  onanism, 
loss  of  animal  fluids,  and  in  impoverished  old  people, 
phosphorus  is  an  excellent  remedy. 

Ruta  grav. — External  indications. — Pupils  contract 
ed  ;  involuntary  movements  of  the  balls  of  the  eyes  ; 
spasms  of  the  lids. 


AND    ITS    APPENDAGES.  611 

Physical  sensations. — Sense  of  weight  and  pressure 
in  the  eyeballs ;  weakness  of  the  eyes  ;  inclination  to 
read  or  write  by  a  very  strong  light ;  rnuscse  voli- 
tantes  ;  red  halo  surrounding  the  flame  of  a  candle  ; 
cloudy  vision  ;  weariness  of  the  eyes. 

Mental  and  moral  symptoms. — Indifferent,  irresolute 
and  peevish. 

Remarks. — Amaurotic  complaints  arising  from  abuse 
of  the  eyes  with  optical  instruments,  in  reading  fine 
print,  or  working  at  small  objects,  and  also  from  con 
tusions,  and  other  mechanical  injuries,  will  require 
the  use  of  ruta. 

Stramonium. — External  indications. — Pupils  dilated 
and  immovable  ;  eyes  staring,  and  somnolent  or  glis 
tening. 

Physical  sensations. — Sense  of  weight  and  tension 
in  the  eyes  ;  obscuration  of  sight ;  objects  appear 
small  or  double  ;  black  colours  appear  gray  ;  sparks 
and  specks  float  before  the  eyes  ;  objects  seem  sur 
rounded  with  a  red  or  light  border  ;  cloudy  vision  ; 
vertigo  ;  headache. 

Mental  and  moral  symptoms. — Disposition  irritable 
and  touchy  ;  hysterical  and  cataleptic. 

Remarks. — Stramonium  is  suitable  in  paralytic  af 
fections  of  the  optic  nerve  and  retina,  connected  with 
deranged  menstruation,  hysteria,  epilepsy,  and  cata 
lepsy. 

In  incipient  amaurosis,  and  frequent  and  sudden  and 
short  attacks  of  blindness,  wre  may  refer  to  sulphur, 
euphrasia,  arnica,  cannabis,  hyoscyamus,  conium,  aurum, 
digitalis. 

Administration. — -We  are  in  the  habit  of  employing 
from  the  first  to  the  sixth  attenuations.  Repetitions 
should  not  be  made  more  than  once  or  twice  in  the 
twenty-four  hours.  As  soon  as  an  impression  is  ap 
parent,  we  should  await  the  result  before  administer 
ing  again. 

SECTION  XII. 

HYDEOPHTHALMIA,    OR    DROPSY    OF    THE    EYE. 

Diagnosis. — This  disorder  proceeds  from  the  forma 
tion  of  a  preternatural  quantity  of  the  aqueous  or  the 


612  AFFECTIONS    OF    THE    EYE 

vitreous  humours,  while  the  absorbent  vessels  convey 
into  the  circulation  only  their  customary  amount  of 
these  secretions  ;  or  the  humours  may  be  formed  as 
usual,  bat  owing  to  some  defect  or  loss  of  power  of 
the  absorbents,  the  natural  quantity  is  not  taken  up 
and  carried  into  the  circulation.  But  it  is  highly  prob 
able,  in  most  cases,  that  the  disease  is  dependent  on  a 
morbid  condition  of  both  the  secerning  and  absorbent 
vessels,  and  that  the  normal  equilibrium  between  se 
cretion  and  absorption  becomes  thereby  destroyed. 
This  idea  receives  confirmation  from  the  fact,  that 
most  dropsies  of  the  eye  can  be  traced  to  previous 
inflammation  of  the  internal  textures  of  the  organ. 

The  unnatural  accumulation  may  be  confined  to 
the  aqueous  humour  in  the  anterior  chamber,  or  to  the 
vitreous  humour  in  the  posterior  chamber,  or  both  hu 
mours  may  be  affected  at  the  same  time.  When  the 
aqueous  humour  is  alone  involved,  the  disease  may 
be  recognised  by  the  following  marks  :  dimensions  of 
the  cornea  larger  than  natural  ;  increased  size  of  the 
anterior  chamber  of  the  eye  ;  turbid  appearance  of 
the  aqueous  humour ;  partial  or  total  loss  of  motion 
of  the  iris ;  pupil  natural  and  immovable  ;  iris  less 
brilliant  than  natural ;  sense  of  weight  and  tension  in 
the  eyeball ;  weakness  of  sight ;  perversion  of  vision, 
either  in  the  form  of  presbyopia  or  myopia  ;  general 
loss  of  voluntary  motion  over  the  ball ;  partial  or  to 
tal  loss  of  vision. 

When  there  is  a  preternatural  accumulation  of  the 
vitreous  humour,  the  enlargement  of  the  globe  is 
more  deep-seated  ;  the  ball  assumes  a  conical  shape  ; 
the  cornea  is  unusually  prominent ;  the  pupil  is  con 
tracted  ;  there  is  a  diminution  of  vision  ;  myopia  ; 
deep-seated  pains  ;  tension  and  heaviness  ;  impaired 
motion  of  the  eyeball ;  and  eventually,  total  blindness. 
When  the  disease  consists  of  an  unnatural  accumu 
lation  of  both  humours,  we  shall  have  a  combination 
of  symptoms  including  nearly  all  described  under  the 
aqueous  and  vitreous  varieties  of  dropsy.  After  the 
vitreous  humour  has  been  for  some  time  affected,  its 
character  is  changed,  and  it  acquires  a  soft  and  usual 
ly  a  watery  appearance. 

In  many  cases,  the  eye  attains  a  size  so  enormous 


AND    ITS    APPENDAGES.  613 

as  to  protrude  far  from  the  orbit,  and  it  is  thus  ren 
dered  quite  impossible  to  close  the  lids  over  it.  In 
this  condition  the  patient  has  a  frightful  appearance, 
and  the  organ  itself,  from  its  exposure,  is  constantly 
irritated  and  inflamed. 

Causes. — The  immediate  cause  of  dropsies  of  the 
eye,  is  an  undue  action  in  the  arteries  which  secrete 
the  humours,  and  a  diminished  action  of  the  absorbent 
vessels  ;  or,  sometimes,  an  inordinate  aqueous  or  vi 
treous  secretion,  with  a  normal  action  of  the  absorb 
ents. 

Hydrophthalmia  is  generally  supposed  to  depend 
upon  some  constitutional  cause,  like  general  dropsy, 
hydrocephalus,  chlorosis,  or  secondary  syphilis  ;  but 
as  a  general  rule,  it  may  be  traced  to  some  previous 
inflammation  of  the  internal  structures  of  the  eye. 
In  infants  and  young  children,  it  is  often  exceedingly 
difficult  to  discover  the  real  cause,  especially  when 
the  external  indications  are  obscure,  and,  on  this  ac 
count,  the  earlier  history  of  the  case  can  rarely  be 
ascertained ;  but  in  adults,  we  shall  often  be  able  to 
discover  previous  sub-acute  inflammation  in  the  inter 
nal  structures. 

Prognosis. — The  allopathists  deem  this  disease, 
when  fully  formed,  incurable.  They  find  that  no  shed 
ding  of  blood,  no  punishment  of  the  stomach,  bowels, 
salivary  glands,  skin,  or  other  inoffensive  parts  of  the 
body,  can  cure  or  palliate  it.  That  the  prognosis  is 
unfavourable,  we  do  not  deny  ;  but  we  believe  the 
disease  may  often  be  cured  in  its  early  stages.  I  have 
treated  but  two  cases  homoeopathically ;  and  but  one 
with  a  favourable  result.  This  was  of  six  months' 
standing,  confined  to  the  aqueous  humour,  and  with 
but  moderate  distention  of  the  cornea  :  the  other  case 
involved  both  humours,  had  continued  more  than  a 
year,  and  had  arrived  at  the  condition  termed  "  ox 
eye,"  when  the  treatment  was  commenced.  In  this 
instance  paracentecis  became  necessary,  and  the  pa 
tient  ultimately  lost  the  eye. 

So  long  as  the  disease  is  confined  to  its  incipient 
stage,  and  even  after  the  unnatural  accumulation  has 
commenced,  provided  no  serous  disorganization  has 
taken  place  in  the  important  tissues  of  the  eye,  we 


614  AFFECTIONS    OF    THE    EYE 

may  predict  a  favourable  result ;  but  if  organic  lesions 
have  occurred,  and  the  accumulation  in  the  anterior 
or  posterior  chamber  is  considerable,  with  total  loss  of 
sight,  our  prognosis  must  be  unfavourable. 

Therapeutics. — If  the  dropsy  depends  upon  a  con 
stitutional  fault,  our  remedies  must  be  addressed  to 
the  remote  difficulties.  So  long  as  these  continue,  mere 
local  means  will  be  inadequate  to  accomplish  our  ob 
ject  ;  but  constitutional  and  local  remedies  may  be  used 
in  alternation  with  probable  advantage.  If  the  eye  be 
much  distended,  and  medicines  do  not  act  with  suffi 
cient  promptness  and  energy,  the  operation  of  para- 
centesis  may  be  made  to  evacuate  the  superabundant 
humours,  after  which,  the  remedies  will  generally 
prove  sufficiently  powerful. 

We  believe  the  following  to  be  the  best  at  present 
known  :  belladonna,  china,  pulsatilla,  mercurius,  hyos- 
cyamus,  stramonium,  conium,  nux  vom.,  arsenicum, 
plumbum,  aconite,  sepia,  sulphur. 

It  is  doubtful  whether  either  of  these  exercises  a 
positively  specific  influence  upon  the  secretory  and 
absorbent  vessels  affected  in  hydrophthalmia,  but  they 
are  capable  of  acting  upon  the  generally  morbid  con 
dition  upon  which  the  local  disorder  depends,  and  thus 
aid  in  arresting  its  progress,  and  occasionally  in  ef 
fecting  cures. 

Administration. — In  the  same  manner  as  advised  in 
amaurosis. 

SECTION  XIII. 

CATARACT. 

Diagnosis. — Strictly  speaking,  this  disease  belongs 
to  the  province  of  surgery  rather  than  that  of  medi 
cine  ;  but  as  homcEopathy  promises  results  somewhat 
important  in  a  medicinal  point  of  view,  we  take  the 
liberty  of  writing  a  few  words  respecting  the  malady 
in  this  place. 

By  the  term  cataract  is  understood,  an  opacity  of 
the  chrystalline  lens,  or  its  capsule,  which  causes  an 
obscuration,  or  a  total  loss  of  vision.  Authors  recog 
nise  and  describe  several  varieties,  both  of  the  lenti 
cular  and  capsular  cataract,  and  amongst  these,  the 
most  common  are — 


AND    ITS    APPENDAGES.  615 

First.  The  firm  or  hard  cataract,  peculiar  to  old 
people,  and  recognised  by  its  amber  colour,  small  size, 
and  by  its  density  and  hardness.  Vision  is  never  to 
tally  destroyed  in  these  cases,  and  the  structures  of 
the  eye  retain  their  natural  contractility. 

Second.  The  fluid  or  milky  cataract,  caused  by  a 
change  of  the  lens  into  a  white  and  semi-fluid  mass, 
of  so  large  a  size  as  to  nearly  obliterate  the  posterior 
chamber,  impair  the  motions  of  the  pupil,  and  prevent 
the  admission  of  rays  of  light. 

Third.  The  soft  or  caseous  cataract,  which  presents 
an  appearance  somewhat  similar  to  the  last  variety, 
with  the  lens  much  enlarged,  of  a  cheesy  consistence, 
and  of  a  light  gray  or  sea-green  colour,  obliteration 
of  the  posterior  chamber,  impaired  motion  of  the  pu 
pil  and  iris,  and  either  partial  or  total  blindness.  The 
lens,  in  this  variety,  always  presents  an  appearance 
of  more  firmness  and  consistence  than  in  the  milky 
cataract,  and  the  dark  irregular  spots  or  lines  which 
sometimes  traverse  it,  remain  the  same  in  all  posi 
tions  of  the  head,  while  those  which  are  now  and 
then  observed  in  the  milky  variety,  change  their  lo 
cation  with  every  motion  of  the  eyes. 

Fourth.  Capsular  cataract,  consisting  of  an  opacity 
of  the  capsule  of  the  chrystalline  lens.  The  opacity 
commences  at  the  margin  of  the  pupil,  in  the  form 
of  "  distinct,  white,  shining  points,  specks  or  streaks  ; 
its  colour,  therefore,  is  always  very  light,  and  never 
altogether  uniform,  even  when  the  disease  is  com 
pletely  formed." — Beer.  When  this  kind  of  cataract 
occurs  in  children  at  or  soon  after  birth,  it  is  called 
congenital  cataract. 

The  capsular  cataract  does  not  generally  continue 
for  a  long  period  before  the  lens  becomes  involved 
also  in  the  opacity.  When  the  disease  has  been  pre 
ceded  by  a  good  deal  of  inflammatory  action,  we  may 
find  cohesions  of  the  anterior  capsule  of  the  lens  with 
the  urea  ;  or  of  the  posterior  layer  of  the  capsule 
with  the  membrana  hyaloidea  ;  or  of  the  whole  of 
the  capsule  with  the  lens  ;  or  all  the  three  species  of 
adhesion  may  exist  together." — Beer,  p.  318. 

Cataract  is  sometimes  complicated  with  amaurosis. 
This  complication  is  not  always  easy  of  detection,  on 


616  AFFECTIONS    OF    THE    EYE 

account  of  the  symptoms  of  these  diseases  bearing  so 
close  a  resemblance.  When  the  lens  or  its  capsule 
are  alone  affected,  the  opacity  is  immediately  behind 
the  pupil,  the  iris  and  pupil  possess  some  degree  of 
mobility,  and  there  is  some  little  appreciation  of  light ; 
but  when  amaurosis  is  conjoined  with  cataract,  we 
have  the  same  appearance  of  the  lens  or  capsule,  but 
a  dilated  and  immovable  pupil,  an  insensible  and  im 
movable  state  of  the  iris,  and  an  absolute  loss  of 
vision. 

The  first  intimation  we  have  of  a  forming  cataract, 
is  defective  vision  when  attempting  to  read  fine  print, 
or  to  look  at  minute  objects.  As  the  disease  advances, 
all  objects  appear  indistinct ;  a  mist  is  constantly  be 
fore  the  affected  eye ;  a  strong  light  is  required  to 
read  or  write  ;  a  small  speck  now  commences  just 
behind  the  centre  of  the  pupil,  and  continues  to  extend 
until  the  opacity  entirely  obstructs  the  passage  of  rays 
of  light  to  the  eye ;  when  the  opacity  is  complete,  a 
black  ring  is  seen  around  the  edge  of  the  pupil,  and 
the  sight  continues  to  diminish  until  blindness  results. 

Causes. — Frequent  and  long-continued  use  of  the 
eyes  in  reading  fine  print,  writing,  or  looking  at  mi 
nute  objects  by  a  strong  light;  congestion  of  blood  to 
the  eyes,  from  exercise  in  a  hot  sun,  in  furnaces,  and 
other  places  where  hot  and  bright  fires  are  kept  up  ; 
exposure  of  the  eyes  to  irritating  fumes  and  vapours, 
like  sulphurous  acid,  chlorine  and  other  gases,  and 
the  vapours  of  sulphuric  ether,  alcohol,  nitric,  sulphur 
ic  and  muriatic  acids,  hereditary  predisposition,  me 
chanical  injuries,  wounds  of  the  capsule  or  lens. 

Prognosis. — When  the  cataract  is  confined  to  the 
lens,  or  to  its  capsule,  and  no  complications  exist  from 
unnatural  adhesions,  from  amaurotic  symptoms,  or 
from  serious  constitutional  disturbance,  a  favourable 
issue  may  be  expected.  On  the  other  hand,  a  dilated 
pupil,  an  immovable  iris,  a  profound  blindness,  which 
has  been  disproportionate  to  the  gradually  forming 
opacity,  unnatural  adhesions  of  the  capsule,  and  an 
irritable  and  vitiated  constitution,  will  render  our 
prognosis  unfavourable. 

Therapeutics. — Before  resorting  to  the  operation  of 
couching:*  or  extraction,  as  is  so  often  done  bv  the  old 


AND    ITS    APPENDAGES.  617 

school  surgeons,  we  should  always  give  our  medicines 
a  fair  trial.  It  is  quite  true  that  we  have  but  few 
remedies  which  simulate  this  affection  in  their  patho- 
genesis,  yet  the  successful  results  which  have  been 
observed  from  the  use  of  medicines  in  a  few  cases, 
render  it  incumbent  on  us  to  avail  ourselves  of  them 
on  all  proper  occasions. 

After  a  thorough  trial  with  medicines,  if  there  is  no 
prospect  of  amendment,  the  patient  should  be  turned 
over  to  the  surgeon  for  the  necessary  operation. 

In  a  few  cases  of  incipient  cataract,  much  benefit 
has  followed  the  local  employment  of  sulphuric  ether 
vapour  to  the  eye,  and  should  our  internal  remedies 
prove  fruitless,  there  can  be  no  objection  to  a  trial  of 
this  substance. 

As  internal  remedies,  we  suggest,  conium,  pulsatilla, 
magnesia  carb.,  sulphur,  cannabis,  phosphorus,  digitalis, 
spigelia,  euphrasia. 

Conium  and  cannabis  may  be  exhibited  when  the 
cataract  has  arisen  from  a  wound,  or  other  injury  to 
the  eye. 

Magnesia  carb.,  pulsatilla,  digitalis,  and  phosphorus, 
have  proved  curative  in  capsulo-lenticular  cataract, 
either  with  or  without  abnormal  adhesions,  also  in 
opacity  of  the  lens  or  capsule  alone.  These  remedies 
are  useful  when  the  disease  has  been  accompanied 
with  ophthalmia. 

Salpliur  is  appropriate  in  those  cases  which  seem 
to  be  connected  with  a  scrofulous  or  psoric  diathesis. 
It  has  also  been  found  curative  in  cataract  compli 
cated  with  amaurosis.  Euphrasia  or  spigelia  may 
sometimes  be  alternated  with  sulphur  with  benefit. 

Administration. — The  same  as  in  amaurosis. 

SECTION   XIV. 

FUNGUS  H.EMATODES,  AND  CANCER  OF  THE  EYE. 

Diagnosis. — Fungus  luzmatodes  has  always  been 
confounded  with  scirrhus,  or  cancer,  until  Burns,  Hey, 
and  Abernethy  pointed  out  the  characteristics  of  the 
two  diseases,  both  in  respect  to  their  formation  and 
development,  as  well  as  their  pathology.  They  pos 
sess  several  qualities  in  common,  like  malignancy,  in- 


618  AFFECTIONS    OF    THE    EYE 

evitable  tendency  to  the  destruction  of  the  affected 
parts,  the  power  of  contaminating  the  whole  system, 
and  giving  .rise  ultimately  to  fatal  constitutional 
symptoms  ;  but  in  other  respects,  they  are  entirely 
dissimilar.  Fungus  haematodes  is  not  usually  attend 
ed  with  the  severe  stinging  and  lancinating  pains  of 
cancer  ;  its  texture  is  spongy  and  elastic,  and  is  soft 
and  apparently  fluctuating  under  the  touch,  while  the 
scirrhus  is  hard  and  stony.  When  fully  formed,  the 
fungous  tumour  is  of  the  consistence  of  brain,  is  of  a 
dark  and  livid  hue,  and  bleeds  on  the  slightest  touch, 
while  the  substance  of  cancer  is  hard,  fibrous,  and 
cartilaginous  ;  at  its  commencement,  and  during  its 
development,  the  fungus  is  knotty  and  unequal,  and 
thus  affords  a  sign  which  distinguishes  it  from  can 
cerous  and  other  tumours.  Fungus  is  more  prone  to 
occur  in  young  subjects,  while  cancer  is  for  the  most 
part  confined  to  persons  past  the  middle  age.  Fungus 
of  the  eye  commences  in  the  posterior  chamber,  while 
cancer  of  the  eye  attacks  primarily  the  conjunctiva 
or  lachrymal  gland.  The  progress  of  fungus  is  more 
rapid  and  destructive  than  that  of  cancer. 

The  first  symptom  observed  in  fungus  haematodes, 
is  defective  vision,  and,  on  looking  into  the  eye,  a 
small  shining  spot  is  perceived  at  the  bottom  of  it. 
This  nucleus  of  the  disease  commences  in  the  re 
tina  and  optic  nerve,  is  traversed  by  branches  of  the 
central  artery  of  the  retina,  and  progresses  from 
within  outwards  through  the  vitreous  humour,  ab 
sorbing  it  in  its  course,  until  it  arrives  near  the  iris, 
when  it  presents  a  dark  amber  or  greenish  hue,  and  is 
apt  to  be  mistaken  for  cataract.  As  the  enlargement 
increases,  the  ball  of  the  eye  becomes  prominent,  ir 
regular,  and  knotty,  the  cornea  ulcerates,  and  the 
disease  displays  itself  externally  in  the  form  of  a  soft, 
medullary,  and  purple  fungus,  bleeding  at  the  least 
touch.  The  pupil  becomes  dilated  and  immovable  in 
the  early  part  of  the  complaint,  and  also  somewhat 
changed  in  colour,  which  becomes  a  strongly  pro 
nounced  amber  or  brown  when  the  swelling  arrives 
at  the  iris.  The  sclerotica  soon  acquires  a  dark  blue 
colour,  is  crossed  by  dilated  veins,  and  is  sometimes 
attacked  by  the  malady  as  well  as  the  cornea.  After 


AND    ITS    APPENDAGES.  619 

the  fungus  has  shown  itself  externally,  the  absorbent 
glands  of  the  jaw  and  neck  become  affected  with  a 
medullary  degeneration  ;  the  countenance  assumes  a 
sallow  and  cadaverous  appearance  ;  general  debility 
and  nervous  irritation  occur  ;  loss  of  appetite  ;  im 
paired  digestion  ;  nausea ;  irritable  stomach ;  rest 
lessness,  and  the  usual  symptoms  of  hectic  fever  ter 
minate  the  patient's  existence. 

Cancer  of  the  eye,  as  we  have  before  remarked, 
generally  attacks  persons  advanced  in  life.  This 
disease,  unlike  fungus  haernatodes,  commences  in  the 
conjunctiva,  caruncula  lachrymalis,  or  lachrymal 
gland,  in  the  form  of  a  hard  warty  excrescence,  which 
continues  for  an  indefinite  period,  sometimes  attended 
with  twinging  and  lancinating  pains,  at  other  times 
free  from  all  uneasy  feelings,  until  finally  its  interior 
structure  becomes  altered  in  texture,  "an  ichorous 
matter  forms  within  the  swelling,  which  gradually 
makes  its  way  to  the  surface,  and  thus  develops  the 
first  stage  of  ulceration.  When  arrived  at  this  point, 
vision  is  destroyed,  an  irregular  fungous  mass  shoots 
up  from  the  ulcerated  point,  highly  vascular,  of  a  red, 
brown,  or  livid  colour,  and  easily  excited  to  haemor 
rhage.  As  the  mass  increases,  the  tissues  of  the  eye 
become  distended  ;  the  ulceration  and  sloughing  ad 
vance  ;  severe  lancinating  pains  dart  through  the 
globe ;  the  appetite  is  impaired  ;  the  patient  loses 
fiesh,  strength,  and  courage  ;  sleep  is  disturbed;  the 
countenance  assumes  an  anxious,  distressed,  and  sal 
low  appearance  ;  hectic  fever  sets  in,  and  the  sufferer 
speedily  yields  to  the  last  result. 

Hitherto  the  diseases  under  consideration  have 
usually  been  deemed  incurable  by  internal  remedies, 
and  on  this  account  surgeons  have  advised  the  early 
extirpation  of  all  suspected  tumours,  hoping  in  this 
way  to  eradicate  the  affection  while  it  is  local,  and 
before  the  mass  of  blood  becomes  contaminated.  But 
it  must  be  admitted,  even  \vhen  the  operation  has 
been  resorted  to  early,  and  under  the  most  favourable 
circumstances,  that  a  lamentable  want  of  success  has, 
for  the  most  part,  followed  all  surgical  measures. 
Stealthy  and  insidious  at  their  commencement,  they 
gradually  glide  along,  depositing  in  all  surrounding 


620  AFFECTIONS    OF    THE    EYE 

textures  their  destructive  and  fatal  poison,  until  dis 
organization  begins,  when  the  livid,  foul,  and  de 
structive  phenomena  appear  in  their  hideousness,  ra 
pidly  communicating  their  influence  through  the  whole 
organism,  and  baffling  all  efforts  of  the  physician  and 
surgeon. 

But  though  experience  has  so  little  of  promise,  we 
cannot  admit  that  there  are  no  remedies  in  the  whole 
range  of  the  materia  medica  capable  of  counteracting 
this  morbid  influence.  We  may  yet  find  some  medi 
cine  sufficiently  specific  to  cure  these  diseases  during 
their  forming  stage.  We  believe,  indeed,  that  homoeo- 
patby  will,  ere  long,  accomplish  all  that  we  require  in 
this  matter.  Only  a  limited  number  of  well  authenti 
cated  homoeopathic  cures  of  true  medullary  fungus, 
or  of  cancer,  have  been  reported  ;  but  the  results  in 
these  few  cases  should  inspire  us  with  some  confi 
dence  of  success,  especially  during  the  early  period 
of  the  maladies. 

Causes. — The  immediate  cause  of  medullary  fungus 
and  of  cancer  is  involved  in  doubt.  Some  have  sug 
gested  the  operation  of  animalculae,  others  of  a  subtle 
poison,  and  others  of  a  kind  of  unhealthy  inflamma 
tion  caused  by  some  constitutional  defect.  Sir  Astley 
Cooper  supposes  the  morbid  degeneration  always  to 
be  "  preceded  by  a  disposition  in  the  constitution  to 
its  production." 

There  is  unquestionably  a  specific  morbid  action  in 
the  tumour  itself,  but  whether  this  is  owing  to  some 
poison  which  acts  specifically  upon  the  particular  part 
alone,  or  to  some  constitutional  vice,  we  are  unde 
cided.  That  there  are  drugs  capable  of  neutralizing 
this  morbid  influence,  whether  it  be  constitutional  or 
local,  we  entertain  no  doubt. 

The  exciting  causes  are  blows,  contusions,  obstruc 
tions  of  blood  from  pressure,  and  mechanical  injuries 
generally,  although  the  disease  often  originates  with 
out  any  apparent  or  traceable  cause. 

Prognosis. — In  our  present  state  of  knowledge,  the 
prognosis  must  be  generally  unfavourable  ;  but  not 
many  years  will  elapse  before  this  state  of  things  will 
change,  and  we  shall  be  able  to  meet  the  complaint 
with  sure  and  efficient  specifics. 


AND    ITS    APPENDAGES.  621 

Therapeutics. — Having  had  but  little  personal  expe 
rience  in  regard  to  the  homoeopathic  treatment  of 
these  affections,  we  shall  simply  allude  to  the  medi 
cines  which  appear  to  us  most  appropriate,  and  refer 
the  reader  to  the  reports  of  cases  which  have  been 
cured  by  other  practitioners. 

Belladonna  has  cured  malignant  disease  of  the  eye, 
attended  with  violent  pains  in  the  eyeball  ;  a  red 
shining  point  in  the  posterior  chamber;  pupils  dilated 
and  immovable ;  loss  of  vision  ;  unusual  hardness  of 
the  substance  of  the  eye  ;  iris  of  a  dark  colour,  and 
covered  with  injected  bloodvessels. 

Malignant  affections  of  the  eye  have  also  been 
cured  by  conium,  carbo  vegetabilis,  arsenicum,  mercu- 
rius,  acid  nit.,  calcarea  carbonica,  and  iodine. 

Administration. — The  same  as  in  amaurosis. 

SECTION    XV. 

AFFECTIONS    OF    THE    APPENDAGES    OF    THE    EYE. 
HORDEOLUM.  — -STYE. 

Diagnosis. — This  is  a  small  boil-like  swelling  in  the 
edge  of  the  eyelid,  resembling  in  size  and  general  ap 
pearance  a  barleycorn.  It  generally  commences  in 
the  follicles  of  Meibomius,  near  the  angle  of  the  eye, 
soon  assumes  a  dark  red  or  purple  colour,  and  becomes 
quite  painful  from  the  violence  of  the  accompanying 
inflammation.  The  inflammation  sometimes  confines 
itself  to  the  cellular  membrane,  and  advances  very 
slowly  to  the  suppurative  stage,  thus  causing  not  only 
highly  troublesome  local  pains,  but  a  considerable 
degree  of  febrile  disturbance.  In  these  cases,  gan 
grene  and  sloughing  of  the  cellular  membrane  is  apt 
to  occur,  and  either  protract  the  cure,  or  leave  the 
part  in  a  condition  liable  to  take  on  a  renewed  mor 
bid  action  from  the  smallest  exciting  cause.  In  other 
instances,  suppuration  occurs  speedily,  the  abscess 
bursts  and  discharges  itself  freely,  and  a  prompt  cure 
results. 

Causes. — Use  of  highly  spiced,  fat,  and  stimulating 
food  ;  disordered  stomach  and  bowels ;  abuse  of  the 
eyes  in  reading,  writing,  or  sewing  by  gas-lights ; 
scrofulous,  psoric,  and  other  impurities  of  the  blood. 


622  AFFECTIONS    OF    THE    EYE 

Therapeutics. — The  appropriate  remedies  are,  sul 
phur,  pulsatilla,  staphysagria,  sepia,  ly  cop  odium.  We 
usually  employ  the  third  attenuation,  and  administer 
a  dose  twice  daily  until  the  swelling  and  inflamma 
tion  disappear. 

SECTION  XVI. 

ENTROPIUM. INVERSION    OF    THE    EYELIDS. 

Diagnosis. — This  affection  consists  of  an  unnatural 
turning  inwards  of  the  whole  or  a  portion  of  the  tar 
sus  and  eyelashes,  in  such  a  manner  as  to  keep  up  a 
constant  irritation  of  the  globe,  and  thus  generate  a 
troublesome  chronic  ophthalmia.  If  the  disease  is 
allowed  to  continue  for  any  length  of  time,  the  cornea 
loses  its  brilliancy,  its  vessels  become  injected,  and 
ulcers  form  ;  there  is  continual  lachrymation  ;  partial 
or  entire  loss  of  vision  ;  great  pain  and  annoyance 
from  the  presence  of  the  offending  eyelashes. 

Causes. — Cicatrices  arising  from  previous  ulceration 
of  the  tarsi ;  chronic  ophthalmias  ;  relaxation  and 
paralysis  of  the  lids  ;  ulceration  of  the  ciliary  glands. 

ECTROPIUM. EVERSION    OF    THE    EYELIDS. 

Diagnosis. — Eversion  of  the  lids  may  be  caused  by 
a  swelling  and  relaxation  of  the  lining  membrane  of 
the  eyelid,  which  presses  the  edge  of  the  lid  forward 
until  it  becomes  everted,  or  by  a  contraction  of  the 
skin  of  the  lid,  in  consequence  of  the  healing  of 
wounds,  ulcers,  carbuncles,  burns,  boils,  etc.  The 
consequences  of  eversion  are,  constant  exposure  of 
the  globe  to  external  irritating  causes ;  chronic  in 
flammation  of  the  eye  ;  frequent  discharge  of  tears  ; 
dryness  of  the  ball ;  photophobia ;  nebulous  spots 
and  ulcers  of  the  cornea. 

Causes. — The  principal  causes  of  eversion  in  conse 
quence  of  swelling  of  the  lining  membrane  of  the  lid, 
are,  protracted  chronic  ophthalmias  of  a  scrofulous 
nature  ;  relaxation  from  intemperance  or  old  age  ;  a 
diseased  state  of  the  follicles  of  Meibomius  ;  morbid 
growths  in  the  part.  Other  causes  of  eversion  are, 
cicatrices  on  the  skin  of  the  lid  arising  from  incisions, 
burns,  ulcers,  smallpox  pustules,  and  carbuncles. 


AND    ITS    APPENDAGES.  623 

Therapeutics — The  medicines  which  have  been 
commended  in  these  affections  are,  hepar  sulphur, 
mercurius  sol.,  calcarea  carb.,  digitalis,  borax. 

Should  these  remedies  disappoint  our  expectations, 
a  portion  of  the  lid  should  be  excised,  in  such  a  man 
ner,  and  in  such  a  situation  that  the  healing  cicatrix 
will  restore  the  displaced  tarsi  and  cilia  to  their  nor 
mal  position.  The  operation  is  simple,  unattended 
with  danger,  and  quite  efficient.  If  opacity  or  ulcer- 
ation  of  the  cornea  has  already  commenced  when  we 
are  first  called  to  the  case,  it  will  be  advisable  to 
have  recourse  to  the  operation  without  delay,  and 
correct  all  local  or  constitutional  faults  afterwards, 
with  suitable  medicines. 

The  attenuations  and  repetitions  of  doses  the  same 
as  in  amaurosis. 

SECTION    XVII. 

FISTULA    LACHRYMALIS. 

Diagnosis. — Under  this  head  authors  generally  in 
clude,  obstruction  of  the  puncta  lachrymalis  and  of 
the  lachrymal  canals,  inflammation  and  suppuration 
of  the  lining  membrane  of  the  lachrymal  sac,  and 
inflammation,  thickening,  and  obstructions  of  the 
membrane  lining  the  ductus  ad  nasum. 

In  the  most  simple  form  of  the  complaint,  there 
will  be  merely  an  obstruction  of  the  puncta,  arising 
from  disease  of  the  Meibomian  glands,  or  of  the  eye 
lids,  and  a  consequent  interruption  to  the  passage  of 
tears  to  the  lachrymal  sac.  The  manifest  symptoms 
in  this  instance  will  be,  a  continual  watering  of  the 
eye  and  overflow  of  tears  upon  the  cheek,  weakness 
of  vision,  and  an  undue  dryness  of  the  nostril  of  the 
affected  side. 

Another  form  of  the  complaint  commences  in  the 
lachrymal  sac,  manifesting  itself  in  the  form  of  a 
small,  hard,  and  circumscribed  swelling,  apparently 
within  the  sac.  This  swelling  is  quite  tender  to  the 
touch,  and  gradually  increases  in  size  until  suppura 
tion  occurs,  when  the  parts  over  and  around  the  tu 
mour  acquire  a  red  and  shining  appearance,  not  un 
like  erysipelas.  During  the  early  period  of  the  in- 


624  AFFECTIONS    OF    THE    EYE 

flammation,  the  puncta  are  closed,  and  tears  are 
forced  over  upon  the  cheek.  The  inflammation  also 
extends  down  the  nasal  canal,  causing  a  degree  of 
tenderness,  dryness,  and  obstruction  in  the  duct  and 
nostril.  If  the  suppurative  process  continues  un 
checked,  the  sac,  after  becoming  much  distended, 
bursts,  and  gives  gradual  exit  to  the  enclosed  pus, 
thus  reducing  the  swelling,  and  developing  a  fistula 
of  the  lachrymal  sac.  During  the  suppurative  process, 
the  inflammatory  action  frequently  extends  to  the  ex 
ternal  textures  of  the  eye,  and  if  the  patient  be  scro 
fulous  or  highly  irritable,  some  constitutional  disturb 
ance  may  be  present. 

If  the  disease  is  permitted  to  increase,  or  if  inju 
dicious  surgical  interference  has  seriously  injured  the 
affected  tissues,  we  may  expect  adhesive  inflamma 
tion  between  the  walls  of  the  membrane  of  the  nasal 
duct,  and  permanent  obstruction  to  the  passage  of 
tears  to  the  nostril,  and  also  a  closure  of  the  lachry 
mal  canals.  When  this  state  of  things  happens,  the 
tears  run  over  the  cheek  as  fast  as  formed,  and  we 
are  presented  with  the  disease  termed  stillicidium 
lachrymarum. 

Still  another  form  of  the  malady  consists  in  a  pri 
mary  inflammation  and  thickening  of  the  membrane 
of  the  ductus  ad  nasum,  which  gives  rise  to  a  partial 
or  total  obstruction  to  the  passage  of  the  tears,  and 
their  consequent  accumulation  in  the  lachrymal  sac. 
This  undue  lachrymal  accumulation  induces  disten- 
tion  of  the  part,  and,  after  a  time,  inflammation  of  its 
lining  membrane,  and  the  other  consequences  which 
we  have  before  enumerated.  This  form  of  fistula  is 
dependent  upon  some  disease  of  the  nostril,  like  sy 
philitic,  scrofulous,  mercurial,  and  cancerous  ulcera- 
tions,  or  inflammation  of  the  nasal  membrane  from 
other  causes. 

When  the  malady  is  fully  developed,  it  is  difficult 
to  decide  in  which  particular  structure  the  inflamma 
tion  originated ;  but  our  diagnosis  will  always  be 
facilitated  by  carefully  considering  the  causes  of  the 
affection,  and  the  previous  inflammations.  In  what 
ever  part  it  commences,  the  inflammation  is  certain 
to  extend,  sooner  or  later,  to  the  contiguous  struc 
ture*?. 


AND    ITS    APPENDAGES.  625 

Causes. — Scarpa  advanced  the  idea,  that  all  forms 
of  fistula  lachrymal  is  were  attributable  to  a  disease 
of  the  minute  glands  of  Meibornius,  or  an  inflamma 
tion  of  the  lining  membrane  of  the  eyelid.  This  idea 
has  been  partially  refuted  by  several  eminent  ocu 
lists,  but  there  is,  notwithstanding,  much  truth  in  the 
theory.  According  to  our  own  observations,  those 
forms  of  fistula  which  have  originated  in  the  puncta, 
or  lachrymal  sac,  have  been  preceded  by  an  inflam- 
ntation  of  the  Meibomian  glands,  or  of  the  conjunc 
tiva  of  the  eyelids  ;  but  where  the  disease  has  origi 
nated  in  the  ductus  ad  nasum,  it  may  generally  be 
traced  to  a  previous  inflammation,  ulceration,  or  in 
jury  to  the  mucous  membrane  of  the  nostril. 

The  remote  causes  which  predispose  to  the  affec 
tion  are,  a  scrofulous,  syphilitic,  or  mercurial  taint ; 
general  debility  and  tendency  to  membranous  inflam 
mations  ;  caries  of  the  nasal  bones  ;  fractures  and 
other  injuries  in  the  region  of  the  lachrymal  sac  and 
nasal  duct ;  chronic  ophthalmia  ;  pressure  of  tumours 
against  the  lachrymal  sac  and  the  puncta. 

Prognosis. — Previous  to  suppuration  of  the  sac, and 
if  there  is  only  a  partial  obstruction  in  the  lachrymal 
canals,  we  may  anticipate  a  prompt  cure  by  internal 
remedies.  But  if  the  puncta  and  nasal  duct  be  en 
tirely  closed,  and  the  suppurative  stage  in  the  sac  is 
far  advanced,  our  prognosis  must  be  unfavourable  or 
evasive.  Much,  however,  must  always  depend  upon 
the  condition  of  the  system,  and  the  causes  and  com 
plications  which  influence  each  particular  case. 

Therapeutics. — Various  methods  have  been  pro 
posed  by  surgeons  for  the  cure  of  fistula  lachrymalis, 
but  they  have  proved  for  the  most  part  unsatisfactory. 
The  different  surgical  means  which  have  been  most 
commended  are,  the  introduction  of  a  tube  or  style 
into  the  nasal  duct ;  the  injection  of  the  sac  and  na 
sal  canal,  through  the  puncta,  by  means  of  Anel's 
syringe,  and  the  introduction  of  quicksilver.  That 
cures  have  now  and  then  followed  each  of  these  me 
thods,  we  do  not  deny  ;  but  the  numerous  instances  of 
permanent  aggravation  of  the  malady  by  their  em 
ployment,  render  it  probable  that  there  has  been 
altogether  more  injury  than  benefit  from  their  intro- 

27 


626  AFFECTIONS    OF    THE    EYE,    ETC. 

duction  into  surgical  practice.  The  same  opinion  is 
at  this  time  entertained  by  several  distinguished  oph 
thalmic  surgeons.  It  therefore  becomes  us  to  inves 
tigate  all  of  the  causes  and  accompanying  symptoms 
of  each  particular  case,  that  we  may  better  select 
remedies,  and  thus  combat  with  a  prospect  of  success 
the  remote  as  well  as  the  immediate  symptoms. 

The  following  medicines  have  been  found  curative 
in  the  various  forms  and  stages  of  the  complaint : 
calcarea  carb.,  acid  nit.,  hepar  sulph.,  silicia,  aurum, 
petroleum,  belladonna,  iodine,  digitalis,  lachesis,  lycopo- 
dium,  kali  carb.,  natrum  carb. 

The  lower  attenuations  are  always  to  be  preferred, 
and  the  dose  repeated  every  twelve  or  twenty-four 
hours  until  the  disordered  tissues  are  suitably  im 
pressed. 


THE   END. 


INDEX. 


A.  PAGE 

Abdomen,  dropsy  of,      -         -  539 

"    tympanitic  distention  of,  259 

Abdominal  typhus,        -        -  190 

Acne, 245 

Acute  ophthalmia,        -        -  580 

Acute  rheumatism,         -         -  524 

Albugo,         -         -         -      582,  601 

Allopathy,    -         -         -        -  61 

Amaurosis,   -  605 

Amenorrho3a,        -         -         -  503 

Anasarca,     -        -        -        -  538 

Angina  pectoris,    ...  359 

"        tonsillaris,          -         -  249 

"        parotitis,            -        -  252 

"        maligna,   -        -        -  200 

Apoplexy,    -                           -  387 

Arachnitis,    -         -         -         -  371 

Arthritis,       -         -         -         -  528 

Ascites,         ....  539 

Asiatic  cholera,     -         -         -  286 

Asthma,        -         -                  -  336 

Attenuations  of  drugs,  <fcc.,     -  111 

B. 

Bilious  colic,          -        -         -  280 

"       fever,         -         -        -  172 

Bladder,  inflammation  of,       -  435 

"      paralysis  of,    -      446, 451 

"       calculi  of,         -         -  454 

"       irritable,                   -  473 

"       suppuration  of,         -  436 

Bowels,  inflammation  of,     269,  270 

"      looseness  of,      -         -  297 

"       torpor  of,  -                  -  258 

"       griping  pains  of,        -  280 

"       haemorrhage  from,     -  270 

"       protrusion  of,     -          •  299 

"      flatulent  distention  of,  258 

Brain,  diseases  of,          -"      -  364 

"       inflammation  of,           -  371 

"       softening  of,        -         -  380 

"       dropsy  of,                       -  381 

"      extravasation  of  blood 

upon,      -        -        -  387 


PAGE 

Brain,  effusion  of  serum  upon,    389 

"       induration  of,      -         -    404 

Bright's  granulated  kidney,  533,535 

Bronchitis,  acute,  -        -         -316 

"         chronic,         -        -     317 

Bubo,  ....     474,489 

C. 

Calculi,         ....  454 
Calculi  of  the  bladder,  457, 459, 460 
"      of  the  kidneys,   -      459,460 
"      of  the  prostate  gland,  458,459 
Cancer  of  the  eye,         -        -  617 
Cardialgia,    -  267 
Carditis,        -         -         -         -  361 
Cataract,       -         -         -        -  614 
Catarrh,        ....  306 
Causes  of  disease,  general,     -  36 
"  "  of  fever,     -         -         -  136 
Cellular  dropsy,  -        r        -  538 
Cerebral  typnus,  -         -         -  183 
Cerebritis,     -  380 
Cerveau,  ramollissement  du,  -  380 
Chancre,       ....  435 
Chest,  dropsy  of,    -         -         -  542 
Chemosis,     -         -         -         -  581 
Chicken  pox,         -         -         -  217 
Chlorosis,      -  555 
Cholera  asphyxia,      ,-.-,      -  286 
"       morbus,     -         -         -  295 
"       infanturn,-         -         -  297 
Chorea,         -         -        -         -  419 
Chronic  ophthalmia       -         -  587 
Colic,  bilious,         ...  280 
"      flatulent,      -        -         -  281 
"      painter's,     -         -         -  282 
Cold,    -         -.-        -        -  306 
Conjunctiva,  acute  inflamma 
tion  of,          -  580 
"           chronic    do.     do.  587 
granulations  of,  -  599 
Constipation,         -        -        -  258 


628 


INDEX, 


Consumption,  pulmonary,       -  341 

Continued  fever,    -                  -  172 

Convulsions,  -         -      383,  421 

Cornea,  inflammation  of,         -  601 

"       ulcers  of,  -         -         -  582 

"       opacity  of,          -         -  600 

Coryza,          -         -         -         -  306 

Cough,  357 

"      whooping,  -         -         -  334 

Croup,                                        -  308 

Cutaneous  diseases,  febrile,     -  198 

"               "         chronic,  -  235 

Cynanche  larvngea,       -        -  307 

trachealis,      -         -  308 

Cystitis, 435 


D. 

Delirium  tremens,  394 
Dementia,     -         -         -         -  402 
Diabetes,      -         -         -         -  436 
Diagnosis,  general,         -         -  122 
Diarrhoea,     -         -         -         -  297 
Dilatation  of  the  heart,  -         -  359 
Diseases,  common  causes  of,  -  36 
Diseases  of  the  cutaneous  system  198 
"         "      digestive  system,  247 
"         "      respiratory  do.  304 
"         "      circulating  do.  359 
Diseases  of  the  brain  and  ner 
vous  system,  -         -         -  364 
Diseases  of  the  spinal  marrow 

and  its  membranes,         -  *  410 
Diseases  of  the  urinary  and 

genital  organs,  -                  -  432 
Diseases  of   the  fibrous  and 

muscular  system,       -  5  24 
Diseases  of  the  serous  exhal- 

ent  vessels,                  -         -  530 

Diseases  of  lymphatic  system,  555 
Diseases  of  the  assimilative  or 
gans,         -                             -566 
Diseases  of  the  eye  and  its 

appendages,      -         -         -  578 

Dispepsia,  see  Dyspepsia. 

Doctrines,  medical,  &c.           -  I 

Doses,  repetition  of,      -  111 

Dropsy,  general,   -         -         -  530 

"       of  the  abdomen,         -  539 

"      brain,      -         -  381 

"      chest,      -         -  542 

«     eye,        -        -  611 

"           "     ovarium,          -  543 

"           "     testicle,            -  544 

Drugs,  primary  and  secondary 

action  of,        -         -         -  49 


Drugs,  attenuations  of, 
Dysentery,    - 
Dysmenorrhcea,     - 
Dyspepsia, 
Dysuria, 


PAGE 

-  Ill 

-  270 

-  513 

-  258 

-  464 


Ecthyma,      - 

Ectropium,    - 

Eczema,        - 

Encephalitis, 

Enteritis,  acute  peritoneal,     - 

"     mucous, 
chronic    do.  - 
Entropium, 
Enuresis,       - 
Epilepsy, 
Eruptive  diseases,  acute, 

"         chronic, 
Erysipelas,   - 
Exanthemata, 
Eye,  diseases  of,    - 

"    acute  inflammation  of,   - 

"    chronic          "  "     - 

"    purulent       " 

'•    gonorrhceal  "  "     - 

"    scrofulous     " 

"    dropsy  of,     - 

"    fungus  haematodes,  and 

cancer  of, 
"  blindness   of,     (see  cata 
ract,    amaurosis,  granu 
lated  lids,  opacity  of  the 
cornea,  cancer,  etc.) 


242 
622 
242 
371 

269 
270 
270 
622 
442 
383 
198 
235 
227 
198 
578 
580 
587 
590 
591 
592 
611 

-     617 


Fever, 


F. 


-     132 

"  intermittent,  -  -  141 
"  yellow,  -  -  -  159 
"  continued,  ..  -;  .  -  172 
"  infantile  remittent,  -  168 
"  typhus,  -  -  176 

"      from  functional  derange 
ment,     -        -         - 

Fever,  from  congestion, 
"      from  inflammation, 
"      hectic,        ... 
"      scarlet,       -        -       ,  - 
"      lung, 
"      brain, 

"      miliary,      -       V 
"      puerperal, 

Fistula  lachrymalis, 
"      in  perineo,    •-.  •-, 

Flatulence,   - 


172 
174 
173 


198 
322 
371 
218 
.278 
623 
472 
259 


INDEX, 


629 


PAGE 

496 

617 


Fluor  albus, 
Fungus  haematodes, 

a 

Gastritis,  acute,    -        -         -  253 

"         chronic,          -         -257 

Gastralgia,  gastrodinia,          -  267 

General  diagnosis,          -         -  122 

"        dropsy,    -         -         -  530 

Genital  organs,  diseases  of,    -  432 

Gleet, 470 

Glossitis,       .         ...  247 

Gonorrhoea,  -         -         -         -  465 

Gonorrhoea!  ophthalmia,         -  591 

Gout,  acute,          -         -         -  528 

"     chronic,        -         -        -  529 

Granulations  of  the  eyelids,  599 

Gravel,          -         -         -         -  454 
Granulated  kidney,  Bright's  533, 535 

H. 

Hsematemesis,       -         -         -  266 
Haemorrhage  from  the  lungs,  352 
"             "       "    stomach,  266 
"       "    bowels,  270 
"             "       •'    uterus,  517 
"       "    urethra,  466 
Haemorrhoids,        -         -         -  299 
Haemoptysis,         -         -         -  352 
Heart,  diseases  of,          -        -  359 
"      dilatation  of,       -         -  359 
"      disease  of  the  valves  of,  360 
"      inflammation  of  the  en 
velop  of,         -         -         -  361 
Heart,  palpitation  of,          360,  361 
"      dropsy  of,           -         -  542 
Hectic  fever,          -         -         -  196 
Hepatitis,  acute,    -        -         -  302 
chronic,          -         -  303 
Hernia  humoralis,          -         -  474 
Herpes,         -                  -         -  236 
Hip-disease,           -         -         -  568 
Homoeopathy,       -         -         -  86 
Hooping  cough,     -         -         -  384 
Hordeolum,            -'       -    •     -  621 
Hydatids  of  the  uterus,         -  497 
Hydrocephalus,  acute,           -  381 
"               chronic,         -  382 
Hydrothorax,         -                  -  542 
Hydrophobia,        -        -         -  414 
Hydrocele,    -        -       >        -  544 
Hydrophthalmia,  -        -        -  611 
Hydrops,      -         -         -         -  530 
Hypertrophy  of  the  heart,      -  359 
Hypochondria,       -        -        -  401 


Hysteria, 


PAGE 
421 


Indigestion,            -     ,-'.;.     -  258 

Impetigo,      -         -         -         -  243 

Inflammation,       -        -        -  '  1 

"            of  the  brain,     -  371 

"     "    lungs,     -  322 

"     "     pleura,  -  328 

"     •'     heart  and 

its  appendages,  359 

Inflammation  of  the  stomach,  253 

"             "     "    liver,      -  302 

"     "    bowels,  269,270 

"     "    kidneys,  432 

"     "    bladder,  435 

"     "    uterus,  51 3, 519 

"     "    eye    and 

its  appendages,  578 

Inflammation   of    the    spinal 

marrow  and  its  membranes,  410 

Inflammation  of  the  joints,     -  568 

"     "     urethra,  465 
"     "     inguinal 

glands,  474 

Inflammation  of  the  tonsils,  249 
"  "  parotid 

glands,  252 

Inflammation  of  the  tongue,  247 
"  '•  peritoneum,  278 
"  "  prostate 

gland,  472 

"             "     "  bronchia,  316 

"     "  testes,  482 

Incontinence  of  urine,    -         -  442 

Infantile  remittent,         -         -  168 

Influenza,      -  307 

Ileus,    -         -        -;-"      -         -  271 

Insanity,       ....  397 

Intermittent  fever,         -        -  141 

Intestines,  inflammation  of,    -  270 

Inversion  of  the  eyelids,         -  622 

Irritable  bladder,           -         -  473 

Ischuria,        -         -         -         -  443 

Itch,     -         -         -  »      -         -  240 


Jaundice, 


J. 


K, 


303 


Kidney,  Bright's  disease  of,  533, 535 

Kidneys,  inflammation  of,      -    432 

"       suppuration  of,        -     433 

"       induration  of,  -    433 

"       schirrhus  of,    -        -     433 


630 


INDEX. 


Kidneys,  gangrene  of,    - 

PAGE 

434 

PAGE 

Ovarian  dropsy,     -                 -    643 

L. 

P. 

Lachrymal  fistula, 

623 

Painter's  colic, 

282 

Lepra, 

245 

Painful  menstruation,     - 

513 

Leucoma,      -         -         -     582,  601 

Palpitation,  - 

359 

Lids,  granulated, 

599 

Papular  diseases,  -         -        - 

239 

Leucorrhoaa,          -        -    475, 

496 

Paralysis,  palsy,    -         -         - 

392 

Lichen,          - 

232 

Parotitis,       - 

252 

Liver,  inflammation  of.  - 

302 

Pathology,  general    observa 

Lung  fever,  - 

322 

tions  on, 

7 

Lungs,  bleeding  from,    - 

352 

Pemphigus,  - 

238 

"      tubercles  of, 

345 

Pericarditis, 

361 

ulcerations  of, 

346 

Peritoneal  enteritis, 

269 

"      hepatization  of, 

323 

Peritonitis,  acute,  - 

278 

•'      congestion  of,     - 

323 

chronic, 

280 

"     purulent  infiltration  of, 

324 

Pertussis,      -         -         -         - 

334 

Phthisis  pulmonalis, 

341 

M. 

Phrenitis,      - 

371 

Mania, 

399 

Phymosis,      -         -         -         - 

469 

Mania  a  potu,         ... 

394 

Piles,     

299 

Marasmus,    - 

669 

Pityriasis,      - 

246 

Measles,        - 

207 

Plague,         .         ... 

235 

Medical  doctrines,  &c.,  - 

1 

Pleurisy,  pleuritis, 

328 

Melancholia, 

401 

Pneumonia,  - 

322 

Menses,  suppression  of,  - 

503 

Porrigo, 

244 

"       retention  of, 

503 

Primary  and  secondary  action 

"       scanty,     - 

513 

of  drugs, 

49 

painful,    - 

513 

Prolapsus  ani,        - 

299 

"       profuse,    - 

517 

"         uteri,     a         -         - 

498 

Menorrhagia,         - 

517 

Prostate  gland,  diseases  of,  450, 

472 

Miasmata,     -         -         -         - 

140 

Prurigo,         - 

240 

Miliary  fever,  Miliaria,  - 

218 

Psora,   -        -         -        -        - 

240 

Monomania, 

401 

Psoriasis,       - 

246 

Mucous  enteritis,   -        -        - 

270 

Puerperal  fever,     - 

278 

Mumps,         .         ... 

252 

Pulmonary  consumption, 

341 

"           affections,     - 

304 

N. 

Purulent  ophthalmia,    - 

590 

Nephritis,      - 

432 

Pustular  diseases, 

240 

Nervous  system,  diseases  of,  - 

364 

Pyrosis,         - 

258 

Nettle  rash,  -         -  -  -  221 

Neuralgia,     -  424 

Nebula,         -        -  -  582,601 

0. 

Ophthalmia,  acute,  -  -  580 

"             chronic,  -  -  587 

"             purulent,  -  -  690 

"            gonorrhceal,  -  591 

strumous,  scrofu 
lous,  -  -  -  -  592 
Opacity  of  the  cornea,  -  -  600 
Opisthotonos,  -  -  -  410 
Os  uteri,  imperforate,  -  .508 
Ovarian  disease,  -  643 


Quinsy, 


Q. 


11. 


249 


380 


Ramollissement  du  cerveau,  - 
Remedial  agents,  specific  ef 
fects  of,                            -  40 
Remittent  fever,    -        -        -  168 

"      infantile,      -  168 

Repetitions  of  doses,      -         -  1 1 1 

Respiratory  organs,  diseases  of,  304 
Retention  of  the  menses,      603, 506 

"      urine,  -         -  443 

Rheumatism,  acute,       -        -  524 


INDEX. 


631 


Rheumatism  chronic, 

Roseola, 

Rubeola, 

Rupia, 

S. 

Scabies, 

Scarlet  fever, 

Scarlatina,     - 

Scarlatina  simplex, 
"         anginosa, 
"          maligna, 

Schirrus  of  the  eye, 


PAGE 

-  525 

-  220 

-  207 

-  243 


-  240 

-  198 

-  198 

-  199 

-  199 

-  200 

-  617 
uterus,   -     619,497 

Scrofula,        -        -        -        -  566 
Scrofulous  ophthalmia,        568,  592 
"         disease  of  the  me- 
senteric  glands,      -        -  569 
Secondary  syphilis,        -        -  488 
Serous  exhalent  vessels,  dis 
eases  of,  530 
Skin,  acute  diseases  of,           -  198 
"    chronic  diseases  of,        -  235 
Sloughing  of  the  cornea,        -  582 
Smallpox,     -         -        -         -  212 
Softening  of  the  brain,  -         -  380 
Specific  eflfects  of  morbific  and 

remedial  agents,  40 

Squamous  diseases,        -        -  245 
Spinal  marrow,  inflammation 

of,          -        -        -  'J    -  410 

Sporadic  cholera,  -  295 

Strictures  of  the  urethra,        -  470 

St.  Anthony's  fire,          -        -  227 
Stomach,  acute  inflammation 

of,          ....  253 
Stomach,  chronic  inflammation 

of,          ....  257 
Stomach,  neuralgia  of,  -        -  267 
"       acidity  of,        -        -  259 
Suppression  of  the  menses,  503,  606 
"       urine,        -  443 
Susceptibilities  of  parts  great 
est  in  disease,         -  64 
Stye,     -         -                           -  621 
Syphilis,        -        -'      -        -  482 


T. 

Tetanus, 

Testes,  inflammation  of, 

"      dropsy  of, 
Tetter, 
Therapeutics, 
The  plague,  - 


PAGE 

Tic  douloureux,               -  -  424 

Tongue,  iuflammation  of  -  247 

Tonsils,  inflammation  of  -  249 

Tonsilitis,       -        ...  249 

Trachealis  cynanche,  -  308 

Typhus,         -  -  176 

"       cerebralis,  -  183 

"      pneumo,    -        -  -  187 

"      abdominalis,      -  -  190 

U. 

Ulcers  of  the  cornea,  -  -  682 

"  "  "  surface,  -  -  488 

"  "  "  throat,  <fec.  -  488 

"  "  "  lungs,  -  -  346 

Urethritis,    -                 -  -  465 

Urethra,  inflammation  of,  -  465 

"  strictures  of,  -  452, 470 

Urinary  calculi,  -  -  -  454 

"  organs,  diseases  of,  -  432 

Urine,  incontinence  of,  -  -  442 

"  suppression  of,  -  -  443 

"  scalding  of  the,  -  -  466 

"  increased  secretion  of,  436 

"  bloody,  -  -  -  467 

"  saccharine,  -  -  440 

"  coagulable,  -»•  -  533 

Urticaria,     -        -        -  -  221 

Uterus,  inflammation  of,  513,  519 

"  hemorrhage  from,  -  517 

"  scirrhus  of,  -  -  497 

•'  prolapsus  of,  -  -  498 

"  polypi  of,  -  -  497 

"  hydatidsof,  -  -  497 

"  congestion  of,  .  613,519 


Valves  of  the  heart,  diseases 

of,      l   >  ".:.»•  .-.       -  360 

Varicella.    -         »  •  •  *        .  217 

Variola,       -          -  •        .  212 

Venereal  disease,  -  -        -  482 

"         node,     -  -        -  489 
Vital  principle,  <fec.,  doctrines 

respecting,    -  -        -  22 

Vomiting  of  blood,  -         -  266 


W 


410     White  swelling,    - 

482    Whites, 

544 

236  Y 

36    Yellow  fever, 
236 


568 
496 


-     159 


OF  THE         r>>\ 

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3—^      3503  Life  Sciences  Bldg.     642-2531 


DAN  PERIOD 


l-M 

ALL  BOOKS  MAY  BE  RECALLED  AFTER  7  DAYS 
Renewed  books  are  subject  to  immediate  recall 

sf  ^V^ 

DUE  AS  STAMPED  BELOW 


v^bftject  to  Recall 
Immediately 


APRivm 


SUBJECT  TO  RECALL 


diately 

AR  1 1  '64  -t 


REC'D  BiOb 


DRM  NO.  DD4 


UNIVERSITY  OF  CALIFORNIA,  BERKELEY 
BERKELEY,  CA  94720 


®s 


UNIVERSITY  OF  CALIFORNIA,  BERKELEY 
FORM  NO.  DD4,  12m,  12/80        BERKELEY,  CA  94720 


and  practice  of  medicine 


17  193 


T: 


JUN  10 


/ 073Z8 


BIOLOGY 
LIBRARY      • 
THE  UNIVERSITY  OF  CALIFORNIA  LIBRARY 


Sir. 


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/•^•Py  5 

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